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QUIZ    QUESTIONS: 


OOUESE 


DENTAL  PATHOLOGY  AND  THERAPEUTICS 


PHILADELPHIA  DENTAL  COLLEGE. 


PROF.  J.  FOSTER  FLAGG,  D.D.S. 


AKSWERED    BY 

WILLIAM    C.    FOULKS,    D.D.S., 

FORMERLY      DZMONSTBATOE     AND    INSTErCTOR    IN    THE     PHILADELPHIA    DENTAL     COLLEGE. 


THIRD   EDITION,   REVISED  AND  ENLARGED. 


PHILADELPHIA  : 

The  S.  S.  White  Dental  Manufacturing  Company, 

PHILADELPHIA,    NEW   YORK,   BOSTON,   AND   CHICAGO. 


Copyright,  1885,  by  Wm.  C.  Foulks,  D.D.S. 


ALL    RIGHTS    RESERYED. 


DEDICATION 


TO 

J.    FOSTER   FLAGG,   D.D.S., 

IX    RKCOGNITION    OF 

HIS    UNTIRING,    PERSEVERING,  AND    FAITHFUL    LABOR    IN    THE 

FURTHERANCE    OF    A    PROPER,    COMFORT-GIVING,    AND 

SCIENTIFIC    PRACTICE    OF    DENTISTRY, 

THIS   WORK 

IS    RESPECTFULLY    DEDICATED. 


PREFACE  TO  THIRD  EDITION. 


To  meet  the  large  and  increasing  demand  for  "Quiz 
Questions,"  the  publication  of  a  third  edition  has  been 
required. 

The  book  has  been  revised  and  enlarged,  and  is  again 
offered  to  the  Dental  Profession  as  a  work  for  rejereuce 
in  daily  office  practice. 

It  is  believed  by  the  author  to  be  the  only  hook  that 
contains  in  a  condensed  and  practical  form  the  general 
facts  and  principles  of  Dental  Pathology  and  Thera- 
peutics, as  enunciated  by  Prof.  J.  Foster  Flagg,  D.D.S., 
in  his  lectures  at  the  Philadelphia  Dental  College,  upon 
the  treatment  and  saving  of  teeth. 

W.  C.  F. 


CONTENTS. 


PAOE 

Gknkral  Principles 1-24 

Deciduous  Teeth 24-25 

Pathological  Dentition 25 

Lancing 26-28 

Permanent  Teeth 28 

Dental  Caries  ;  Tables  of  Periods  of  Decay  and  of 

Kelativk  Liability  of  Teeth  to  Decay        .        .  29-33 
Methodic  Examination  and  Positions  of  Teeth  Lia- 
ble TO  Decay' 33 

Sensitive  Dentine -  .  34-35 

Galvanic  Action  of  Unlike  Fillings,  etc.         .        .  35-36 

Superficial  Caries 36 

Simple  Caries  and  Topical  Applications  for  Sensi- 
tive Dentine 37-44 

Pulp  Protectors  against  such  Medicaments       .        .  44-45 

Three  Other  Local  Obtunding  Applications     .        .  44-46 

Medicaments,  etc.,  for  General  Effect      ...  46 

Deep-Seated  Caries •        .  47-57 

Temperament  and  Conservation  of  the  Dental  Pulp.  57-65 


8  COXTEXTS. 

PARE 

Ptilp  CAPPi>fG 65-68 

ExTERifAL  Irritation  to  Pulps 68-69 

PiTLP  Nodules  and  Absorption  of  Permanent  Eoots.  69-71 

Phantom  Odontalgia — Fungous  Gum  and  Pulp  .        .  71-72 

Complicated  Caries 72-81 

Extirpation  of  the  Dental  Pulp 80-83 

Dental  Exostosis 83-85 

Fused,  Attached,  and  Geminous  Teeth        .        .        .  85-86 

Periodontitis       .        .        • 86-91 

Alveolar  Abscess 91-95 

Appendix. 

Miscellany 97-109 

Medicaments 109-122 

Capsicum  B1.gs     .        .                123 


DENTAL  PATHOLOGY  AND  THERAPEUTICS 


GEXEEAL    PEINCIPLES. 

What  is  that  force  called  upon  \vliicli  all  re- 
sponse to  remedial  effort  depends  ? 

Alls.    Vis  Vitce. 

What  is  this  force  called  as  a  conservator  ? 

Ans.    Vis  Conservatrix. 

What  as  a  medicator  ? 

Ans.    Vis  lledicatrix  Naturce. 

AVhat  is  the  employment  of  indicated  means  for 
relief  called? 

Ans.  Ars  3Iedencli. 

What  is  the  theory  of  relief  called  ? 

Ans.  Ratio  Medendi. 

What  are  the  meaning  and  use  of  "  hyj^er," 
"hypo,"  "a"  or  "an,"  "epi,"  "itis"? 

Ans.  "  Hy2:»er,"  above,  excessive;  "hypo,"  under, 
beneath,  deficiency  ;  "  a"  or  "  an,"  without,  lacking ; 
"  ej^i,"  upon,  on ;  "  itis,"  inflammation. 

Define  the  Princij^tles  and  Practice  of  Dentistry. 

Ans.  The  general  Principles  of  Medicine,  ap- 


10  DENTAL  PATHOLOGY 

plied  to  the  treatment  of  disease,  as  related  to  the 
teeth. 

What  is  "  Dental  Pathology  and  Therapeutics"  ? 

Ans.  Dental  pathology  considers  the  causes  and 
different  forms  of  the  various  diseases  to  whicli 
the  teeth  are  liable.  Dental  therapeutics  considers 
the  medicines  and  remedies  which  are  used  in  the 
treatment  of  such  diseases. 

Define  the  terms  "  Disease,"  "  Etiology,"  "  Semi- 
ology," "  Nosology,"  "  Diagnosis,"  "  Prognosis," 
"  Prophylaxis,"  and  "  Hygienics." 

Ans.  "  Disease,"  alteration  of  nutrition ;  "  Eti- 
ology," causes  of  disease ;  "  Semiology,"  phenomena 
of  disease;  "Nosology,"  classification  of  disease; 
"  Diagnosis,"  distinction  of  disease ;  "  Prognosis," 
the  foretelling  of  the  course  and  termination  of 
disease ;  "  Prophylaxis"  and  "  Hygienics,"  preven- 
tion of  disease. 

What  is  the  first  natural  division  of  "  essential 
precedents"  to  disease? 

Ans.  "  Extrinsic"  and  "  Intrinsic." 

What  is  the  meaning  of  these  terms  ? 

Ans.  "  Extrinsic,"  external  agencies  which 
operate  on  the  body  or  mind  ;  "  Intrinsic,"  causes 
existing  within  the  body,  independent  of  any 
obvious  external  influence. 

What  is  the  second  natural  division  of  these 
terms  ? 

Ans.  "  Predis230sing"  and  "  Exciting." 


AND   THERAPEUTICS.  11 

Are  these  causes  always  of  the  same  class  ? 

Ans.  They  are  not. 

Are  they  susceptible  of  transposition  ? 

Ans.  They  are.  The  exciting  cause  may  be  the 
predisposing,  or  the  j^redisposing  may  be  the  ex- 
citing cause. 

Into  what  two  classes  are  the  Exciting  causes  of 
disease  divided? 

Ans.  "  Coo-nizable"  and  "  Non-coo;nizable" 
agents. 

Name  some  of  the  Cognizable. 

Name  some  of  the  Non-cognizable. 

Ans.  (See  Table  I.) 

TABLE   I. 

EXCITING   CAUSES   OF   DISEASE. 

f  Mechanical. 
I   Chemical. 
Ingesta. 
Cognizable        I   Bodily  exertion. 


Agents. 


1   Mental  emotion. 
Excessive  evacuation. 
Suppressed  or  defective  evacuation. 
Defective  cleanliness,  ventilation,  and  drainage. 
Temperature  and  changes. 


Endemic. 

Epidemic 

I  Infectious. 

What    is    the    division    of    the   "elements"    of 


^  f  Jbinclemic.     ~i 

-Cognizable    I        . ,      .       \   ^  . 

.  {   Epidemic.     >  Poisons. 

Agents.  \  ^  \.     . 

L  Infectious.  J 


disease  ? 

Ans.  Primary  and  Proximate. 


12 


DENTAL .  FA THOL OGY 


TABLE   II. 

PRIMARY   ELEMENTS    OE   DISEASE. 


Structural. 
Contractile  Fibre  . 

Nervous  Structure 
Secretory  Tissue     . 


Constituents  of  the  Blood 


Blood  in  Circulation 


Drawn  Blood 


Functional. 


!   Irritability. 
Tonicity. 


Sensibility. 

Vol.  Motion, 
j  Keflex  action. 
I   Sympathy. 

Secretion. 

{  Red  corpuscles 

White  corpuscles 

Fibrin    .     . 
-j  Albumen    . 

Fatty  matters 

Salts  .     .     . 

Water    .     . 


140. 


3. 

70. 

4. 

6. 

777. 


j   Bed    and   white    corpuscles 
]       and  liquor  sanguinis. 

Bed  and  white  corpuscles 
and  fibrin  forming  "clot" 
and  serum. 


Any  of  the  above  elements,  pathologically  viewed,  may  be  Ex- 
cessive, Defective,  or  Abnormal. 


AND   THERAPEUTICS. 


13 


TABLE   III. 

PROXIMATE    ELEMENTS    OF    DISEASE. 


Blood 

IN 

Circulation. 


Nutrition  of 
Tissues. 


Defective,    I   General. 
Anremia.     |  Local. 


General. 


f  Increased, 
I       "Sthenic." 
Diminished, 
"  Asthenic' 


Excessive, 
Plethora. 


l^  Local. 

Perverted,  Cachaeniia. 
Defective,  Atrophy. 

Excessive,  Hypertrophy, 
Perverted. 


f  Increased, 

"  Determination." 
Diminished, 

"  Congestion." 
Partly    increased    and 
partly  diminished, 
"  Inflammation." 
Terminations, 
"  Resolution," 
"  Suppuration," 
"  Gangrene," 
"  Mortification," 
"Sloughing,"  (?) 
"  Caries," 
"  Necrosis," 
[       "  Exfoliation."  (?) 

\  Degenerations. 
-!   Depositions. 
Growths. 


14  DENTAL  PATHOLOGY 

What  is  meant  by  "  cathartics"  ? 

Ans..  Medicines  which  increase  the  alvine  dis- 
charges. 

What  other  terms  are  relatively  analogous,  and 
what  are  their  meanings  ? 

Ans.  "  Aperients,"  from  aperio,  to  open ;  "  Laxa- 
tives," from  laxo,  laxatum,  to  loosen ;  "  Purga- 
tives," from  purgo,  purgatum,  to  cleanse,  to  purge ; 
"  Drastic"  Purgatives,  from  the  Greek  drastikos, 
powerful,  active ;  "  Hydragogues,"  from  the  Greek 
hudor,  water,  and  hago,  to  bring  away ;  "  Chola- 
gogues,"  from  the  Greek  chola,  bile,  and  hago,  to 
carry  off,  to  bring  away. 

Name  medicaments  and  peculiarities. 

Ans.  Aperients  are  small  doses  of  the  saline 
cathartics;  such  as  Citrate  of  Magnesia,  Tartrate 
of  Potassium,  BitartratQ  of  Potassium,  Seidlitz 
Powders,  etc.  A  very  mild  action  upon  the  whole 
tract  of  the  bowels  is  produced  by  this  class. 

Laxatives. — Tamarinds,  Manna,  Cassia,  Castor 
Oil,  Aloes,  "  Tropical  Fruit,"  Fresh  or  Dried  and 
Stewed  Fruits,  Bran,  Sugar,  Molasses,  etc.  These 
are  usefully  employed  in  habitual  constipation, 
and  promote  a  mild  action  of  the  bowels. 

Purgatives. — Rhubarb,  Aloes,  Castor  Oil,  Sa- 
lines, etc.  This  class  is  more  decided,  but  similar 
in  action  to  the  last  mentioned;  generally  pro- 
motes three  or  four  stools. 

Drastic  Purgatives. — Croton  Oil,  Gamboge,  Ep- 


A^W   THERAPEUTICS.  15 

soni  Salts,  Hellebore,  etc.  This  class  causes  severe 
action  of  the  bowels,  together  with  griping,  irrita- 
tion, and  pain.  They  are  especially  indicated  in 
cases  where  derivation  is  desired. 

Hydrago(/ucs. — Elaterium,  Colocynth,  Jalap, 
Senna,  Podophyllum,  etc.,  produce  large  and 
watery  stools.  They  are  used  in  various  sthenic 
inflammatory  diseases  for  the  purpose  of  deple- 
tion. 

Cholagogues. — Podophyllum,  Calomel,  Blue 
Mass,  etc.  These  medicines  increase  the  flow  of 
bile ;  used  in  altered  conditions  dependent  U230n 
the  liver.  Much  difference  of  opinion  exists  as  to 
whether  any  medicines  may  be  correctly  termed 
cholagogues. 

How  do  cathartics  act  ? 

Ans.  In  three  ways :  1st,  by  stimulating  the 
nuiscular  coat  of  the  bowels,  to  augment  peri- 
staltic action;  .2d,  by  increasing  the  discharge 
from  the  mucous  membrane  and  glands  of  the 
alimentary  canal ;  3d,  by  causing  a  greater  flow  of 
bile. 

For  what  are  cathartics  used  ? 

Ans.  1st,  to  unload  the  bowels ;  2d,  to  promote 
secretion  and  relieve  habitual  constipation ;  3d,  for 
depletion  in  inflammatory  diseases. 

How  is  "  Hypercatharsis"  to  be  checked  ? 

Ans.  B}''  the  use  of  opiates, — sometimes  by 
stimulants. 


16  DENTAL  PATHOLOGY 

What  are  "  diuretics"  ?     Name  some. 

Ans.  Medicines  wliicli  increase  the  secretion  of 
urine.  Acetate  and  Nitrate  of  Potassium,  Squills, 
Colchicum,  Copaiba,  Water,  etc. 

What  are  "  diaphoretics"  ?     Name  some. 

Ans.  Medicines  which  moderately  increase  per- 
spiration. Spirit  of  Mindererus,  Citrate  of  Potas- 
sium, Spirit  of  Nitre,  Water,  etc. 

What  are  "  sudorifics"  ?     Name  some. 

Ans.  Medicines  which  j)roduce  copious  perspira- 
tion. Dulcamara,  Ij^ecacuanha,  steam-bath,  violent 
exercise,  AVater,  etc. 

What  are  "  exj^ectorants"  ?     Name  some, 

Ans.  Medicines  which  cause  discharge  from  the 
air-passages.  Solution  of  Muriate  or  Carbonate 
of  Ammonia,  Tar,  Vinegar,  Ether  Vapors,  Wild 
Cherry,  Tolu,  Ammoniac,  etc. 

What  is  "  depletion"  ?     What  is  "  sedation"  ? 

Ans.-  Blood-letting;  though  the  system  may 
be  depleted  by  cathartics,  diaphoretics,  starvation, 
etc.  Sedation  implies  depression  of  the  vital 
power. 

What  are  "  emmenagogues"  ? 

Ans.  Medicines  which  excite  or  j)i"omote  the 
menstrual  flow ;  most  of  them  are  uteiine  tonics. 

W^hat  are  "  sialagogues"  ? 

A71S.  Medicines,  irritants,  etc.,  which  increase 
the  flow  of  saliva  and  mucus. 

What  are  "  errhines"  ? 


AND   THERAPEUTICS.  17 

Ans.  Metliciiies,  stimulants,  and  irritants  which 
are  employed  to  make  an  impression  upon  the 
Schneiderian  membrane,  causing  more  or  less  dis- 
charge of  mucus  from  the  nose.  When  sneezing 
is  produced  they  are  termed  sternutatories. 

What  is  a  "  seton"  ? 

Ans.  A  strip  of  linen  passed  through  skin  and 
cellular  tissue,  and  allowed  to  remain ;  frequent 
moving  of  the  strip  produces  "  counter-irrita- 
tion." 

AVliat  are  "  epispastics"  ?     Name  some. 

Ans.  ApjDlications  which  inflame  the  skin,  and 
b)^  their  irritating  action  cause  determination  and 
congestion,  with  concomitant  effusions,  serous  or 
sanious,  which  effusions,  accumulating  between  the 
skin  and  cellular  tissue  at  the  point  of  irritation, 
raise  the  cuticle  into  "  blebs"  or  "  blisters."  Can- 
tharides.  Mustard,  Croton  Oil,  etc.,  are  j^i'ominent 
episjiastics. 

What  are  "  alteratives"  ? 

Ans.  Medicines  which  act  upon  the  functions  of 
nutrition,  to  change  and  neutralize  morbid  or  re- 
dundant matters  in  the  circulation. 

How  is  blood  obtained,  and  how  is  it  rej^len- 
ished  ? 

Ans.  Obtained  by  digestion,  assimilation,  etc., 
and  rej^lenished  by  food. 

What  is  the  "pulse"?  At  what  points  is  it 
taken  ? 


18  DENTAL  PATHOLOGY 

Ans.  "Pulse"  is  the  beating  of  the  heart.  It 
is  taken  at  the  radial,  temporal,  carotid,  brachial, 
and  femoral  arteries,  over  the  heart,  or  at  any 
artery  that  can  be  felt. 

Name  half  a  dozen  varieties  of  pulse  and  their 
opposites. 

Ans.  "  Frequent  and  slow,"  "  hard  and  soft," 
"  quick  and  sluggish,"  "  strong  and  weak,"  "  full 
and  small,"  "  regular  and  irregular,"  "  heavy  and 
light." 

Give  the  normal  frequency  of  the  pulse  from 
foetal  life  to  old  age. 

Ans. 

Foetal  heart ,  140  per  minute. 

Just  after  birth 130 

First  year 110 

Second  year 100 

Fifth  year 90 

Tenth  year 85 

Puberty 80 

Adult 75 

Old  age 80 

What  are  the  ordinarily  classified  constituents  of 
the  blood — the  relative  proportion  in  normal  blood? 

Ans.   (See  Table  11.) 

What  is  the  division  of  the  blood  in  circulation  ? 

Ans.   (S.ee  Table  11.) 

What  is  the  division  of  drawn  blood? 

Ans.  (See  Table  II.) 

What  is  the  first  act  of  vitality  in  connection 
with  the  blood  ? 


AXD    THERAPEUTICS.  19 

Ans.  Coagulation. 

What  is  the  hist  act  ? 

Ans.  Coagulation. 

What  constituent  of  the  blood  seems  nearest 
allied  to  coagulation? 

Ans.  Fibrin. 

What  are  the  three  great  peculiarities  of  clot  ? 

Ans.  1st,  uniform  coagulation  with  little  con- 
traction ;  2d,  uniform  coagulation  with  marked 
contraction  and  plainly  "  cuj^ped" ;  3d,  tough, 
contracted,  and  concave,  with  buffy  coat  (inflamma- 
tory clot). 

What  is  meant  by  the  "  buffy  coat"  ? 

Ans.  The  peculiar  surface  color  of  the  "  inflam- 
matory clot,"  caused  by  the  "  fibrin"  and  "  white 
corpuscles." 

What  is  meant  by  "  aniemia"  ;  "  spantcmia"  ; 
"  hyperremia"  ;  "  jjlethora"  ? 

Ans.  Lack  or  want  of  red  blood ;  poor  blood ; 
local  excess  of  blood ;  fulness  of  blood-vessels. 

How  is  anaemia  divided  ? 

Alls.  Into  "  acute"  and  "  chronic." 

What  is  the  treatment  for  acute  an?emia  ? 

Alls.  Kemove  cause ;  administer  tonics. 

What  is  the  treatment  for  chronic  anicmia  ? 

Ans.  Administer  tonics  ;  remove  cause. 

How  is  2)lethora  first  divided  ? 

Am.  "  Sthenic"  and  "  Asthenic." 

What  is  the  treatment  for  sthenic  plethora  ? 


20  DENTAL  PATHOLOGY 

Ans.  Blood-letting,  actual  and  medicinal  seda- 
tion, diet,  exercise,  etc. 

What  is  the  treatment  for  asthenic  plethora  ? 

Ans.  Blood-letting,  tonics,  stimulants,  altera- 
tives, aperients,  diuretics,  hygienics,  etc. 

How  is  plethora  secondarily  divided  ? 

Ans.  General  and  local. 

How  is  local  plethora  divided  ? 

Ans.  "  Determination,"  "  Congestion,"  "  Inflam- 
mation." 

What  is  the  location  and  peculiarity  of  "deter- 
mination" ? 

Ans.  Location — In  the  arteries  and  arterial  cap- 
illaries. Peculiarity — Excess  of  blood,  with  motion 
increased. 

What  is  its  exciting  cause  ? 

Ans.  Irritation  or  stimulation. 

What  are  its  symptoms  and  effects  ? 

Ans.  Increased  Sensation  ;  Stimulation ;  Hyper- 
trophy. 

What  are  the  four  means  for  treatment  ? 

Ans.  Depletion ;  Derivation  ;  Relaxation  ;  Se- 
dation. 

What  is  the  location  and  peculiarity  of  "  con- 
gestion" ? 

Ans.  Location — Veins  and  venous  capillaries. 
Peculiarity — Excess  of  blood  with  motion  dimin- 
ished. 

AVhat  are  its  symptoms  and  effects  ? 


AXD   THERAPEUTICS.  21 

Ans.  Redness;  bliieness;  purplish  color;  di- 
ininislied  warmth  and  sensibility ;  followed  by 
numbness,  coldness,  and  painful  distention  in  the 
part ;  cessation  of  functional  action  ;  transudations, 
etc. 

What  are  its  four  means  for  treatment  ? 

Ans.  Mechanical ;  Astringents  or  stimulants ; 
Depletives ;  Kubefacients  as  counter-irritants ; 
Evacuants,  etc. 

What  are  the  locations  and  peculiarities  of 
"  true  inflammation"  ? 

Ans.  Location — Arteries,  capillaries,  and  veins. 
Peculiarity — Excess  of  blood,  with  motion  partly 
increased  and  partly  diminished. 

What  are  its  signs  ?     What  its  symptom  ? 

Ans.  Signs — Redness,  heat,  swelling.  Symptom 
—Pain. 

Describe  the  relative  chans-es  of  white  and  red 
corpuscles  which  are  apparent,  microscopically,  in 
inflammation. 

Ans.  White  corixiscles  increase  in  number,  and 
begin  to  adhere  to  the  walls  of  the  vessels ;  some 
stick  in  the  tortuous  capillaries,  thus  arresting  the 
progress  of  the  red  disks.  Some  of  the  white 
globules  work  through  the  walls  of  the  vessels,  and 
ai'e  then  denominated  exudation  corpuscles.  When 
one  of  these  degenerates  it  becomes  a  pus-corpuscle. 

Into  what  classes  is  inflammation  divided  ? 

Ans.  "  Sthenic,"  "Asthenic,"  "  Phlegmonous"  or 


22  DENTAL  PATHOLOGY 

"  Circumscribed,"  "  Erysipelatous,"  "  Syphilitic," 
"  Scrofulous,"  etc. 

What  are  the  three  varieties  of  duration  ? 

Ans.  "  Acute,"  "  Subacute,"  and  "  Chronic." 

What  are  the  two  classes  of  exciting  causes  ? 

Ans.  "  Local  or  direct ;"  "  General  or  indirect." 

What  are  the  three  divisions  of  the  "local  or 
direct"  causes  ? 

Ans.  "  Mechanical,"  "  Chemical,"  and  "Vital." 

What  is  meant  by  these  distinctions,  mechanical, 
chemical,  and  vital  ? 

Ans.  "  Mechanical,"  such  as  a  blow,  wound,  etc. ; 
"  Chemical,"  such  as  an  acid,  escharotic,  etc. ; 
"  Vital,"  such  as  virus,  malarial  poison,  etc. 

What  is  meant  by  "  reaction"  ? 

Ans.  The  "vital  effort"  which  follows  depression. 

What  is  the  result  of  inflammation  ? 

Ans.  Effusion. 

What  are  the  varieties  of  inflammatory  effusions? 

A71S.  "  Euplastic,"  "  Cacoplastic,"  "  Aplastic." 

What  is  the  difference  between  congestive  and 
inflammatory  effusions  ? 

A71S.  Inflammatory  effusions  are  organizable,  and 
congestive  effusions,  as  a  rule,  are  not. 

What  are  the  terminations  of  inflammation? 

A71S.  Kesolution  or  Suppuration. 

What  is  meant  by  "  resolution"  ? 

Ans.  Subsidence  of  inflammation,  more  or  less 
absorjDtion  of  effusions,  and  return  to  normality. 


AXD   THERAPEUTICS.  23 

What  is  the  treatment  in  the  endeavor  to  effect 
resolution  ? 

A71S.  "  Sedatives,"  "  Antiphlogistics,"  "  Evacu- 
ants,"  "  Attennants,"  "  Sorbefacients,"  "  Pressure," 
"  Friction,"  etc. 

What  is  meant  by  "suppuration"? 

A71S.  The  dissolution  and  breaking  down  of  cir- 
cumvallated  jiarts,  Avhich,  with  "  white"  and  "  tis- 
sue" corpuscles,  forms  "  pus." 

What  is  the  treatment  to  effect  this  ? 

Ans.  Stimulation. 

What  is  the  present  theory  of  "  pus-corpuscles"  ? 

Ans.  They  are  the  devitalized  or  degenerated 
"  white  corpuscles"  and  "  tissue-corpuscles." 

What  is  meant  by  the  "  jDyogenic  membrane"  ? 

Ans.  The  "  23arietes,"  or  "  line  of  circumvalla- 
tion,"  between  living  tissue  and  pus. 

What  are  the  symptoms  of  suppuration  ? 

Ans.  Loss  of  color,  paleness,  coldness,  lack  of 
sensibility,  fluctuation  on  tapping,  yielding  on 
pressure,  etc. 

What  is  an  "  abscess"  ?     What  is  a  "  fistula"  ? 

Ans.  A  circumscribed  cavity  containing  pus.  A 
pus-discharging  opening  or  tract  leading  to  an 
abscess. 

What  is  "  pointing"  ?     What  is  an  "  ulcer"  ? 

A71S.  The  tendency  of  pus  to  the  surface.  An 
oj^en,  pus-forming  surface. 

What  is  meant  by  "  Gangrene,"  "  Mortification," 


AND   THERAPEUTICS.  25 

_,.     ,        ,  flower,  11  to  12  months. 

First  molars <  ,o  ,<  i^       <■ 

t  upper,   13  "  14       '• 

„     .  flower,  17  "  18      " 

Canines < 

I  upper,  19  "  20      " 

Second  molars 23  "  30       " 

What  are  some  exceptions  to  the  general  rule  ? 

A71S.  Some  are  born  with  a  few  teeth  erupted, 
and  in  some  cases  with  the  entire  temporary  set ; 
the  lateral  incisors  vary  as  to  the  period  of  erup- 
tion ;  there  are  cases  on  record  of  adults  who  have 
been  edentulous  from  birth. 

To  what  phase  of  dentition  is  infantile  mortality 
largely  due  ? 

Ans.  Pathological  dentition. 

What  are  the  general  symptoms  of  pathological 
dentition  ? 

Ans.  Loss  of  ap]3etite,  peevish  fretfulness,  toss- 
ing restlessness,  actual  wakefulness,  feverish  thirst, 
painful  paroxysms,  continuous  suffering,  bowels 
loose  or  constipated,  congestion  of  brain,  emacia- 
tion, and  death. 

What  are  the  tisual  local  signs  of  abnormal  den- 
tition ? 

Ans.  Eedness  of  gums,  marked  flow  of  saliva, 
desire  to  suck  the  thumb  or  fingers,  biting  the 
spoon  or  ring  with  determination,  alternately  re- 
fusing and  taking  the  breast,  etc. 

What  are  the  exceptions  to  these  ? 

Ans.  AVhen  some  or  all  of  these  sio'ns  are  absent. 

What  is  the  remedy  ? 

3 


'O' 


26  DENTAL  PATHOLOGY 

Ans.  Mechanical.     (Lancing.) 

What  is  the  relative  "  resistance"  between  nor- 
mal and  cicatricial  tissue  ? 

Ans.  Cicatricial  tissue  is  the  weaker,  because  of 
its  secondary  formation. 

How  are  lower  incisors  to  be  lanced  ? 

Ans.  Parallel  with  the  cutting  edges  of  the 
teeth,  and  to  the  inner,  or  lingual  margin  of  the 
gums. 

How  are  uj)per  incisors  to  be  lanced  ? 

Ans.  Parallel  with  the  cutting  edges  of  the  teeth, 
and  to  the  outer,  or  labial  margins  of  the  gums. 

How  are  lower  first  molars  to  be  lanced  ? 

Ans.  Crucially,  from  the  posterior  lingual  cusp 
to  the  anterior  buccal  cusp,  and  from  the  posterior 
buccal  cusp  to  the  anterior  lingual  cusp. 

How  are  upper  first  molars  to  be  lanced  ? 

Ans.  Crucially,  from  the  posterior  aspect  to  the 
anterior,  and  from  the  lingual  to  the  buccal. 

How  are  cuspids  to  be  lanced  ? 

Ans.  Similar  to  incisors  at  first. 

What  is  the  indication  in  pathological  dentition, 
after  the  cusps  of  cuspids  are  erupted  ? 

Ans.  Cut  the  ring  of  gum  at  two  or  four  points. 

How  are  second  molars  to  be  lanced  ? 

Ans.  Same  as  lower  first  molars. 

What  is  the  most  thorough  method  of  lancing 
molars  in  extreme  cases  ? 

Ans.  Take  off  a  block  of  gum. 


AND   THERAPEUTICS.  27 

What  are  the  three  divisions  of  Pathological 
Dentition  ? 

Ans.  Moderate  in  severity,  decided  in  severity, 
dangerous  in  severity. 

Whei*e  is  the  finger  to  be  introduced  in  the  ex- 
amination of  the  mouth  of  an  infant  less  than  ten 
months  old  ? 

Ans.  In  the  corner  of  the  mouth,  as  the  teeth 
giving  trouble  are  not  there  in  process  of  eru^^tion. 

Where  if  more  than  ten  months  old  ? 

Ans.  At  the  front  of  the  mouth,  for  the  same 
reason. 

What  are  the  immediate  dangers  from  lancing  ? 

Ans.  Cutting  the  gums,  cheek,  tongue,  etc.,  either 
from  slii^ping  of  the  instrument,  or  sudden  motion 
of  the  child. 

How  are  these  to  be  guarded  against  ? 

Ans.  Wrapping  the  blade  of  lancet  with  muslin, 
care  in  lancing,  properly  securing  the  child,  and 
anticipating  sudden  starts. 

What  is  the  subsequent  danger  ? 

Ans.  Hemorrhage. 

How  is  hemorrhage  controlled  ? 

Ans.  By  apj^lication  of  "styptics,"  mechanical 
means,  systemic  treatment,  gravity,  etc. 

What  is  the  most  dangerous  form  of  hemorrhage  ? 

Ans.  Slow,  oozing,  atonic  hemorrhage. 

What  is  the  order  of  eruption  of  the  permanent 
teeth  ? 


28  DENTAL  PATHOLOGY 

Ans. 


First  molars from    5 J  to    7  years. 

Central  incisors 

Lateral  incisors 

First  bicuspids 

Second  bicuspids 

Second  molars        

Canines 

Wisdom 


6 
7 
9 
10 
12 
13 
17 


9 
10 
11 
14 
15 
45 


Lower  teeth  precede  the  upper  by  a  few  weeks. 

What  are  the  indications  for  extraction  of  the 
deciduous  teeth  ? 

Ans.  When  the  superior  permanent  oral  teeth 
erupt  inside  the  arch  and  behind  the  deciduous ; 
when  the  inferior  permanent  oral  teeth  in  like 
manner  present  outside  the  arch ;  where,  in  con- 
junction with  frail  and  weakened  constitution, 
complications  are  liable  to  arise  from  their  reten- 
tion. As  a  rule,  it  is  best  that  the  deciduous  teeth 
should  remain  until  the  proper  absorption  of  their 
roots  is  indicated  by  loosened  crowns. 

What  are  the  indications  for  extraction  of  the 
six-year  molars  ? 

Ans.  Where  it  becomes  improbable  that  they  will 
be  comfortably  preserved  for  any  length  of  time ; 
when  so  far  decayed  and  diseased  as  to  fail  in  re- 
sponse to  proper  treatment  before  eru23tion  of  the 
twelve-year  molar ;  when  pulp  is  devitalized  before 
proper  calcification  of  tooth  structure ;  where  pro- 
trusion of  lower  arch,  or  other  irregularity,  or  false 
occlusion  may  be  corrected  by  their  removal. 


^  AND   THERAPEUTICS.  29 

AVhicli  are  generally  the  most  difficult  of  tlie 
permanent  teeth  in  pathological  eruption  ? 

Ans.  Lower  wisdom  teeth. 

What  is  the  first  grand  division  of  all  teeth  ? 

Ans.  Upper  and  lower. 

Name  the  "  faces"  of  the  teeth. 

A71S,  "  Mesial,"  "  Distal,"  "  Labial,"  "  Lingual," 
"  Buccal,"  "  Cutting  edges,"  "  Cusi^s,"  and  '•  Articu- 
lating Surfaces." 

What  is  dental  caries  ? 

Ans.  The  softening  and  decalcification  of  tooth 
structure,  or  disease  of  the  bone  analogous  to  ulcer- 
ation of  the  soft  parts. 

What  is  the  first  cause  ? 

Ans.  Non-cognizable  systemic  influence. 

What  are  the  fivo  divisions  of  the  predisposing 
causes  of  caries  ? 

Alls.  General  and  Local. 

What  are  the  two  divisions  of  general  predis- 
posing causes  ? 

Ans.  Systemic  and  Local. 

What  are  the  three  divisions  of  local  predisposing 
causes  ? 

Ans.  Structure,  Form,  Position. 

Name  some  of  the  systemic  predisposing  causes. 

Ans.  Thermal,  Chemical,  Parasitic. 

Give  the  views  taught  in  regard  to  thermal, 
chemical,  and  parasitic  influences. 

Ans.    Thermal    change    does    not   immediately 


30  DENTAL  PATHOLOGY 

affect  tooth  structure,  but  indirectly  predisposes  to 
decay  by  shock  to  the  pul]3  and  interference  with 
nutrition. 

Chemical  action  may  be  ascribed  to  the  fluids  of 
the  mouth,  decomposing  food,  etc.,  which  soften 
and  decalcify  tooth  structure. 

Parasitic  influence  is  not  exerted  until  decay  has 
commenced, — is  a  concomitant  of  decay. 

Give  the  views  taught  in  regard  to  influences 
dependent  upon  Structure,  Form,  and  Position. 

Ans.  Structure — Teeth  of  hard,  solid  structure 
resist  decay  and  other  destructive  forces  markedly. 
Teeth  of  poor,  soft  structure  soon  fail,  and  rapidly 
yield  to  opposing  influences. 

Form — Teeth  having  deep  sulci,  pits,  depres- 
sions, cracks,  and  fissures  are  more  liable  to  decay 
than  if  perfect. 

Position — Teeth  which  are  crowded  in  any  part 
of  the  mouth,  or  which  do  not  occlude  properly,  are 
liable  to  decay  from  retention  of  food,  inspissated 
mucus,  etc.,  or  from  mechanical  abrasion. 

What  is  meant  by  "  periodicity"  of  caries  ? 

Ans.  Its  recurrence  at  certain  periods,  modified 
by  temperament,  mode  of  life,  physical  condition, 
systemic  drain,  etc. 

INTERVALS    OF    COMPARATIVE 
PERIODS    OF    DECAY.  CESSATION. 

1st 5  to    8  years.  1st  .  between  8  and  12  years. 

2d 12  "  20      "  2d  .  "20    "     30      " 

3d  .....  30  "  35      "  3d  .           "       35    "     45      " 

4th  .     .     .     .     .  45  "  50      "  4tli  .  variable  at         60      " 


AXD    THERAPEUTICS.  31 

PERIODS    OF    DECAY.  INTERVALS    OP   COMPARATIVE 

CESSATION. 

5th GO  to  05  years.         oth     ,  between  65  and  70  years. 

Gth 70  "  75      "  fJtli     •         "        75    "    80     '« 

7th 80    years,      at 

which  time  a  tooth  may  decay 

rapidly,  and  is  soon  followed 

by  death  of  the  patient. 

What  is  taught  in  regard  to  the  effect  of  a  de- 
caying tooth  upon  others  ? 

Alls.  A  decaying  tooth  has  no  destructive  influ- 
ence upon  other  teeth  unless  in  actual  contact,  but 
tends  to  localize  the  trouble  in  the  mouth,  thus  ex- 
empting for  a  time  other  teeth,  wliicli  are  next  liable 
to  decay,  from  any  decided  disintegrating  influence. 

How  are  males  and  females  affected  in  different 
degree  as  regards  caries  ? 

Ans.  Females  are  more  liable  to  caries,  because 
of  mode  of  life,  menses,  pregnancy,  care  of  chil- 
dren, etc. ;  men  have  more  out-door  life,  exercise, 
chew  tobacco,  and  when  free  from  excesses  are 
less  likely  to  be  troubled  with  caries. 

How  do  different  diseases  affect  caries  ? 

Ans.  Disease  does  not  act  upon  tooth  structure 
directly,  but  affects  the  system,  altering  and  de- 
ranging its  normal  working ;  as  a  sequence,  teeth 
which  are  low  in  vitalit}'  suffer. 

How  does  struma  impress  caries  ? 

Ans.  Lowers  general  vitality,  predisposes  to 
formation  of  watery  tissues,  unconsolidated  struc- 
tures, and  markings  on  the  teeth  (which,  however. 


32  DENTAL  PATHOLOGY 

are  not  likely  to  become  centres  of  decay),  so  that 
when  decay  begins  it  makes  rapid  progress. 

What  is  the  theory  of  caries  taught? 

Ans.  Mechanico-Chemico- Vital,  with  Parasitic 
concomitants. 

What  is  taught  in  regard  to  "  brushing"  teeth  ? 

Ans.  A  soft  brush  should  be  used  once  or  twice 
daily,  cleaning  well  the  grinding  and  cutting  sur- 
faces ;  brush  lightly  from  the  necks  over  the  outer 
and  inner  surfaces. 

What  in  regard  to  "pulverized  pumice"  ? 

A71S.  It  is  an  excellent  article  for  cleansing  and 
brightening  teeth,  and  does  not  injure  the  enamel 
or  gums  if  properly  used.  It  should  be  applied 
with  a  soft  pine  stick.  It  is  j^repared  for  dental 
use  from  the  ordinary  pulverized  pumice  by  stir- 
ring in  water  and  allowing  it  to  settle  perfectly : 
this  leaves  all  light  imjourities  floating ;  the  water 
is  then  j)Oured  off,  and  the  pumice  being  stirred  in 
a  second  water,  it  is  allowed  to  settle  for  two  or 
three  seconds  only,  when  the  turbid  water  is  poured 
off";  this  is  again  allowed  to  settle  perfectly,  when 
the  clear  water  is  poured  off  and  the  fine  residuum 
is  dried.     This  is  a  levigated  pumice. 

What  is  the  relative  liability  of  teeth  to  decay  ? 

A71S. 


1.  Lower  first  molar. 

2.  Upper  first  n:iolar. 

3.  Lower  second  molar. 

4.  Upper  second  molar. 


5.  Upper  lateral  incisor. 

6.  Upper  second  bicuspid. 

7.  Upper  central  incisor. 

8.  Upper  first  bicuspid. 


AND   THERAPEUTICS.  i 

9.  Lower  second  bicuspid.  13.  Lower  first  bicuspid. 

10.  Lower  third  molar.  14.  Lower  lateral  incisor. 

11.  Upper  third  molar.  1-3.  Lower  central  incisor. 

12.  Upper  cuspid.  1            16.  Lower  cuspid. 


Of  what  practical  wiportance  is  the  knowledge 
of  this? 

Ans.  It  is  a  safe  guide  for  the  extraction  of 
teeth  under  all  circumstances;  permits  of  a  com- 
2Xtratrve  saving  of  the  best  teeth,  in  correction  of 
irregularities ;  is  a  guide  to  the  "  clasping"  of 
proper  teeth  for  plates ;  is  also  a  general  control- 
ling factor  in  the  practice  of  thorough  dentistry, 
from  the  stand-i^oint  of  saving  teeth. 

How  is  "  methodic  examination"  conducted  ? 

Ans.  Begin  at  any  back  tooth,  and  passing  in 
regular  order,  thoroughly  examine  every  surface 
of  each  tooth. 

Name  the  positions  liable  to  decay  on  each  tooth. 

Ans.  Approximate  surfaces  of  central  and  lateral 
incisors  and  of  molars  and  biscuspids ;  the  sulci  of 
molars  and  biscuspids,  the  basilar  pits  of  incisors 
and  canines ;  the  buccal  faces  and  cervical  margins 
of  molars  and  biscuspids. 

What  are  the  instruments  needed  for  a  thorougli 
examination  ? 

Ans.  Mouth  mirror,  probe,  ligature  or  floss-silk, 
and  wedges. 

What  is  Odontalgia  ? 

Ans.  Pain  in  and  about  a  tooth. 


34  DENTAL   PATHOLOGY 

What  is  the  first  cause  of  odontalgia  ? 
A71S.  Sensitive  Dentine. 


SENSITIVE    DENTIJSTE. 

What  are  the  four  primary  divisions  under 
which  sensitive  dentine  is  discussed  ? 

Ans.  1st,  Cases  with  no  perceptible  cavities  of 
decay ;  2d,  Superficial  Caries ;  3d,  Simple  Caries ; 
4th,  Deep-seated  Caries. 

What  are  the  symptoms  of  "  sensitive  dentine"  ? 

Ans.  Uneasy  sensations,  which  may  be  located 
about  the  teeth,  jaws,  cheeks,  eyes,  nose,  lips,  etc., 
aggravated  by  contact  of  sweets  and  sours ;  position 
of  trouble  not  positively  located  unless  touched. 

What  is  the  special  diagnostic  of  sensitiYe  dentine? 

Ans.  Instant  pain  upon  touch,  instant  cessation 
on  removal. 

CASES   WITH   NO   PERCEPTIBLE   CAVITIES   OF   DECAY. 

What  are  the  locations  for  these  ?    Appearances  ? 

Ans.  About  the  necks  of  teeth,  in  the  sulci,  on 
the  cusps,  articulating  surfaces,  and  cutting  edges. 
At  times  nothing  is  perceptible ;  again  the  sensitive 
parts,  especially  about  the  necks  of  teeth,  are 
smooth,  hard  and  polished,  or  hard  without  polish ; 
again,  soft,  discolored,  unaltered  in  contour,  or 
cupped,  concave  in  the  sulci,  cusps,  and  cutting 
edges. 


AND   THERAPEUTICS.  35 

What  are  the  systemic  considerations  in  regard 
to  acid  vegetables,  fruits,  condiments,  etc.  ?  What 
is  the  medication  ? 

Ans.  They  bring  on  an  acid  condition  of  the 
stomach,  which  in  turn  influences  the  fluids  of  the 
mouth,  causing  sensitive  dentine,  setting  the  teeth 
on  edge,  increasing  existing  decay,  etc.  In  treat- 
ing, forbid  indulgence  (for  a  few  days  or  a  week, 
according  to  severity  of  the  case)  of  food  contain- 
ing sours,  as  pickles,  straw^berries,  aj^ples,  peaches, 
lemons,  tomatoes,  etc.     Medication  is  alkaline. 

What  are  the  domestic  local  applications  ? 

Ans.  Lime,  soda,  chalk,  aqua  ammonia,  phenol- 
sod  ique,  etc. 

What  is  the  domestic  systemic  medication  ? 

Ans.  Half-grain  doses  of  bicarbonate  of  soda  in 
water ;  take  three  or  five  times  daily  for  a  week ; 
phenol-sodique,  five  or  ten  droj^s  in  half  a  tum- 
bler of  water,  and  rinse  the  mouth ;  deprive  of 
acids. 

What  is  the  action  taught  of  two  unlike  metal 
fillings  ? 

Ans.  When  touching,  galvanic  action  is  j)6r- 
mitted,  the  dentine  preserved,  and  a  favorable  con- 
dition of  the  oral  fluids  maintained ;  if  not  in  actual 
contact,  a  shock  may  be  caused  when  the  different 
metals  are  connected  by  the  tongue,  cheek,  or  saliva. 
This  shock  usually  occurs  during  mastication,  and 
varies  in  intensity. 


36  DENTAL  PATHOLOGY 

What  is  tauglit  of  the  union  of  amalgam  and 
gold-plate  ? 

Ans.  From  the  gentle,  continuous,  and  stimula- 
ting galvanic  action  which  is  exerted,  a  beneficial 
effect  is  produced  upon  the  mouth,  and  even  upon 
the  general  health. 

What  severe  complications  pertain  to  sensitive 
dentine,  aside  from  toothache  ? 

An8.  Neuralgic  complications. 

SUPERFICIAL   CARIES. 

What  is  taught  in  regard  to  removal  of  "  super- 
ficial caries"  in  teeth  proportionately  liable  to  be- 


come carious 


? 


Ans.  Superficial  caries  is  that  stage  of  decay 
which  permits  of  its  easy  removal  by  use  of  files, 
burs,  corundum-wheels,  and  the  like.  In  teeth 
liable  to  become  carious,  it  should  be  let  alone  until 
its  progress  indicates  intervention  by  filling. 

SIMPLE    CARIES. 

What  is  simple  caries  ? 

An%.  That  stage  of  decay  where  a  filling  first 
becomes  a  necessity. 

What  is  the  first  remedy  for  "  sensitiveness"  in 
cavities  of  "simple  caries"? 

Ans.  Dryness. 

How  is  this  supposed  to  be  advantageous  ? 

Ans.  Dryness  obtunds  sensibility;    as,  for  ex- 


AND   THERAPEUTICS.  37 

am2)le,  the  tongue,  when  dry,  cannot  transmit  the 
sense  of  taste,  etc. 

What  is  the  second  remedy  ? 

Ans.  Rcqnd  cutting  with  sharp  instruments. 

What  is  the  rationale  of  this  ? 

Ans.  A  finger  may  be  sliot  or  cut  off  quickly, 
and  the  pain  experienced  at  the  moment  will  be 
very  slight ;  the  shock  obtunds  the  nerves  for  the 
time  being.  The  same  explanation  is  given  to  the 
rai^id  cutting  of  dentine. 

What  is  the  proper  method  of  doing  this  ?  Why  ? 

Ans.  Cut  from  within  outwards,  or,  if  an  en- 
gine-bur is  used,  under-cut  lightly  at  the  bottom 
of  the  cavity,  and  then  bur  out  the  dentine  above 
to  the  same  depth.  By  under-grooving,  the  tubuli 
being  cut  at  their  base,  no  sensation  can  be  trans- 
mitted to  the  jDulj). 

Topical  applications.  What  are  the  foicr  class 
divisions  of  these  medicaments  ? 

Ans.  First.  Those  which  do  not  endanger  the 
pulp.- 

Second.  Those  which  may  possibly  endanger  the 

Third.  Those  which  are  liable  to  endauoer  the 
pulp. 

Fourth.  That  which  is  dangerous  to  pulps. 

First.  Those  which  do  not  endanger  the  jjulp. 
Name  ten  or  more  remedies  under  this  head. 

Ans.  Prepared  Chalk,  Bicarbonate  of  Soda,  Oil 


38  DENTAL  PATHOLOGY 

of  Cloves,  Aqua  Ammonia  Fortior,  Chloroform, 
Naboli  No.  1,  2,  and  3,  Nitric  Acid,  Quick-lime, 
Dental  Tincture  of  Aconite,  etc. 

Second.  Those  which  may  possibly  endanger  the 
pulp.  Name  three  or  four  remedies  under  this 
head. 

Ans.  Creasote,  Carbolic  Acid,  Carbonate  of  Po- 
tassium, and  Chloride  of  Zinc. 

Give  the  collodion  and  glycerine  tests  for  crea- 
sote and  carbolic  acid. 

Ans.  Equal  parts  of  glycerine  and  creasote  make 
a  turbid  mixture,  the  creasote  floating  on  top ; 
equal  parts  of  glycerine  and  carbolic  acid  make  a 
clear  solution.  Take  alcohol  and  collodion  equal 
parts,  add  creasote,  a  clear  solution  results.  Take 
alcohol  and  collodion  equal  parts,  add  carbolic 
acid,  a  gelatinized  mass  results. 

Third.  Those  which  are  liable  to  endanger  the 
pulp.     Name  the  three  remedies  under  this  head. 

Ans.  Chromic  Acid,  Phosphoric  Acid,  Ethylate 
of  Sodium. 

What  is  taught  of  phosphoric  acid  ? 

Ans.  Dangerous,  because  of  its  slow,  quiet,  and 
persistent  action :  it  may  be  years  after  its  use  be- 
fore pulp  dies ;  other  remedies  being  safer,  and 
equally  efficacious,  its  use  should  be  avoided. 

Why  is  chloride  of  zinc  called  a  "  polychrest"  ? 

Ans.  Because  of  its  wide  range  of  medicinal  ap- 
plication. 


AXD    THERAPEUTICS.  39 

What  is  the  range  of  medicinal  a|)i)lication  of 
chloride  of  zinc  ? 

A71S.  From  a  mild  antiseptic  and  astringent  to 
a  powerful  escharotic. 

What  is  the  proper  form  in  which  to  use  chloride 
of  zinc  as  an  obtundent  of  sensitive  dentine  ? 

A71S.  Deliquesced. 

Why? 

Ans.  If  used  in  the  form  of  crystal,  it  must 
deliquesce  before  any  action  on  tooth-tissue  takes 
l^lace;  if  it  is  diluted,  its  strength  is  impaired, 
and  an  irritating  instead  of  an  escharotic  effect  is 
produced. 

What  are  the  usual  sensations  from  chloride  of 
zinc  applications  ? 

Ans.  Painful  sensations. 

What  is  the  peculiarity  of  the  pain  ? 

A71S.  Cold,  gradually  increasing  and  gradually 
diminishing  pain. 

What  is  the  method  of  preparing  chloride  of 
zinc  for  dental  use  f 

Ans.  The  crystallized  chloride  of  zinc  is  allowed 
to  deliquesce;  it  is  then  ke2:)t  in  a  glass-stopped 
bottle,  and  is  ready  for  dental  use. 

AVhat  is  the  taste  of  chloride  of  zinc  ? 

Ans.  Sweetish,  metallic,  astringent  taste. 

What  is  the  method  of  a^^plying  chloride  of  zinc  ? 

Ans.  On  a  gold  prolie  or  i)ointed  stick,  pellet  of 
cotton,  or  by  oxychloride  filling. 


40  DENTAL  PATHOLOGY 

What  is  taught  of  the  accompanying  use  of  oil 
of  cloves? 

Ans.  It  stops  the  pain. 

What  is  the  usual  duration  of  pain  from  chloride 
of  zinc  application  ? 

Ans.  From  three  to  ten  or  fifteen  minutes. 

What  are  the  exceptions  to  this  ? 

Ans.  Where  it  lasts  for  an  hour  or  longer. 

What  should  be  the  characteristic  of  the  pain  ? 

Ans.  Steady,  full,  round,  and  bearable. 

What  kind  of  pain  may  supervene  ? 

Ans.  Throbbing,  pulsating,  jumping  pain. 

What  does  this  signify,  and  how  is  it  treated  ? 

Ans.  It  signifies  pulp  irritation ;  treated  by 
soothing,  sedative,  and  antiphlogistic  remedies. 

What  are  the  points  in  regard  to  excavating 
after  chloride  of  zinc  applications  ? 

Ans.  Begin  to  excavate  about  half  a  minute 
after  the  pain  ceases,  then  excavate  only  to  the 
depth  of  the  film  of  obtunded  dentine. 

What  is  the  after-preparation  of  a  cavity  in  which 
the  dentine  has  been  obtunded  by  chloride  of  zinc  ? 

Ans.  Neutralize  by  washing  with  tepid  water, 
and  apply  oil  of  cloves. 

How  is  carbonate  of  potassium  prepared  for 
dental  use  ? 

Ans.  By  mixing  fifteen  grains  of  carbonate  of 
potassium  with  one  drachm  of  glycerine,  and  al- 
lowing it  to  stand  until  clear. 


AND   THERAPEUTICS.  41 

What  is  the  method  of  applying  it  ? 

uins.  On  a  gold  probe,  sharp-pointed  stick,  or  a 
small  jiellet  of  cotton. 

What  is  its  effect  ?     What  are  the  symptoms  ? 

Ans.  Its  effect  is  to  obtund  sensitiveness ;  symp- 
toms same  as  those  induced  by  chloride  of  zinc, 
but  in  much  less  degree. 

How  is  it  neutralized?  What  is  the  sign  of 
complete  neutralization  ? 

Ans.  It  is  neutralized  by  oil  of  cloves ;  if  any 
potassium  is  j^resent  the  oil  of  cloves  turns  yellow ; 
when  the  oil  is  not  discolored,  complete  neutraliza- 
tion has  been  effected. 

What  is  taught  regarding  it  ? 

A71S.  It  is  a  good,  safe,  and  reliable  remedy. 

How  is  chromic  acid  made  ? 

Ans.  By  the  action  of  sulphuric  acid  on  the 
saturated  solution  of  bichromate  of  j^otassium. 
The  sulphuric  acid  unites  with  the  potassa,  and 
sets  free  the  chromic  acid,  which  is  deposited  in 
crystals. 

What  is  its  a2:)pearance  ? 

Ans.  It  is  in  the  form  of  anhydrous  acicular 
crystals,  of  a  brilliant  crimson-red  color,  and  an 
acid-metallic  taste. 

What  kind  of  a  salt  is  it  ? 

Ans.  Deliquescent,  and  very  soluble  in  water. 

In  what  form  should  chromic  acid  be  used  as  an 

obtundent  ? 

4 


42  DENTAL  PATHOLOGY 

Ans.  In  liquid  form. 

In  what  manner  should  one  guard  against  danger? 

Ans.  Never  apply  the  "  rubber  dam"  when  using 
it;  the  acid  is  liable  to  get  beneath  the  dam  and 
do  much  injury  before  discovered;  use  only  in 
easy  or  accessible  cavities  and  hard  teeth. 

Why? 

Ans.  Because  it  gives  no  learning  pain  when 
acting  upon  the  tissues. 

What  of  the  employment  of  chromic  acid  in 
difficult  places  ? 

A71S.  It  should  never  be  used. 

What  are  the  symptoms  accompanying  its  use  ? 

Ans.  Perfect  quiet  for  a  time,  which  may  result 
in  death  of  the  pulp. 

What  are  the  indications  of  danger  ? 

Ans.  Growing,  gnawing  pain. 

What  is  the  after  treatment  ? 

Ans.  The  cavities  should  be  dried  and  saturated 
with  oil  of  cloves. 

How  is  chromic  acid  neutralized,  and  what  is 
the  final  preparation  of  the  cavity  ? 

Ans.  It  is  neutralized  with  chalk,  carbonate  of 
soda,  or  other  alkali.  Finally,  the  cavity  should  be 
dried  and  saturated  with  oil  of  cloves  or  carbolic 
acid,  and  again  dried  prior  to  filling. 

What  is  the  appearance  of  ethylate  of  sodium  ? 

Ans.  Light  straw-color  at  first,  dark  orange- 
yellow  after  keeping. 


A  AD   THFAIAPEUTICS.  43 

How  is  it  applied  ?     What  are  the  symptoms  ? 

Ans.  With  a  gold  Avire  probe  or  shar2)-poiiited 
stick ;  quiets  or  obtunds  sensibility. 

How  is  it  neutralized  ?  What  care  is  needed  in 
its  use  ?     How  is  danger  to  be  avoided  ? 

Ans.  Neutralize  with  bicarbonate  of  soda;  same 
care  as  for  chromic  acid  that  it  does  not  reach  the 
tissues ;  jilace  only  in  accessible  cavities. 

What  dangers  are  liable  from  chromic  acid  and 
ethylate  of  sodium  other  than  danger  to  jDulps  ? 

Ans.  Danoer  to  the  tissues  from  the  ulcerous 
and  unmanageable  sloughing  sores  they  produce. 

Fourth.  That  which  is  dangerous  to  j^ulps.  Give 
the  various  names  of  this  medicament. 

Ans.  Arsenic,  White  Oxide  of  Arsenic,  Arseni- 
ous  Acid,  Ratsbane. 

What  is  cobalt  ?  To  what  is  its  obtunding  power 
due  ? 

Ans.  A  brittle,  reddish-gray  metal,  magnetic, 
slowly  oxidizes  in  the  air ;  occurs  in  combination 
with  arsenic,  to  which  its  obtunding  power  is  due. 

What  is  taught  in  regard  to  the  use  of  arsenious 
acid,  or  cobalt,  for  obtunding  sensitive  dentine  ? 

Ans.  It  should  never  be  used,  as  it  will  sooner 
or  later  devitalize  the  jnilp. 

AVhat  is  taught  in  regard  to  using  very  small 
quantities  of  arsenic,  and  for  limited  j^eriods  of 
time,  to  insure  safety? 

Ans.  If  used  at  all,  it  will  cause  death  of  the  pulp. 


44  DENTAL  PATHOLOGY 

What  medicaments  are  7iot  liable  to  injure  the 
pulp  when  used  for  sensitive  dentine  in  deep-seated 
cavities  of  decay  ? 

Ans.  Chalk,  Carbonate  of  Soda,  •  Acetate  of 
Morphia,  Oil  of  Cloves,  Atropia,  Chloroform,  Al- 
cohol, Camphor,  etc. 

What  medicines  may  possibly  injure  the  pulp  in 
such  cases  ? 

Ans.  Naboli  No.  3,  Carbonate  of  Potassium, 
Nitrate  of  Silver,  ajid,  idiosyncratically,  Creasote 
and  Carbolic  Acid. 

What  medicines  are  liable  to  injure  the  pulp  in 
such  cases  ? 

Ans.  Chloride  of  Zinc,  Chromic  Acid,  Nitric 
Acid,  and  Ethylate  of  Sodium. 

What  are  the  materials  deemed  best  as  pulp- 
protectors  against  such  medicaments? 

Ans.  Zinc  Sulphate,  Temporary  StopjDing,  Cap- 
ping Varnishes,  etc. 

How  are  these  applied  ? 

Ans.  Zinc  Sulphate  is  carried  on  the  end  of  a 
spatula  to  the  cavity,  and  gently  pushed  from  the 
instrument  with  a  probe  to  position  desired ;  the 
material  at  this  stage,  being  of  "  cream-like"  con- 
sistency, adapts  itself  without  presstw-e.  It  is  a 
"  non-irritant,"  and  becomes  "  sufficiently  hard" 
for  a  |)ul23-protector.  Temporary  Stopj^ing  is 
warmed,  pressed  into  wafers  of  the  desired  size, 
picked  up  with  a  warm  probe,  softened,  placed 


AXD    THERAPEUTICS.  45 

in  position,  and  the  edges  sealed  with  a  warm 
burnisher.  Tliis  makes  a  very  thjht  and  non- 
irritating  protector.  Varnishes  are  applied  on  a 
pellet  of  cotton,  which  is  inserted  into  the  cavity, 
gently  "  Avij^ed"  around,  and  quickly  withdrawn. 
This  makes  a  very  thin  Uniny,  and  still  serves  as 
a  pulp-protector. 

What  is  taught  regarding  Zinc  Phosphates  in 
this  connection  ? 

An.i.  In  view  of  the  comparative  uncertainty  and 
doubt  of  their  ultimate  action  uj^on  the  pulp,  it  is 
deemed  best  to  restrict  their  use  to  exjDerimentation. 

Name  three  other  local  applications  for  obtunding 
sensitive  dentine. 

Ans.  Heat,  Cold,  Electricity. 

What  are  the  various  forms  of  heat  ? 

Ans.  Hot  air,  galvanic  cautery,  actual  cautery. 

What  are  the  various  forms  of  cold  ? 

Ans.  Cold  air,  ice,  spraying  of  Sulphuric  Ether, 
Rhigolene,  or  other  volatile  liquids,  on  the  part  to 
be  rendered  insensate. 

How  is  electricity  used  ? 

Ans.  By  means  of  the  "  Dental  Helix." 

What  three  important  considerations  govern  the 
application  of  a  current? 

Ans.  1st,  it  must  be  a  jDrimary  intermitted  cur- 
rent; 2d,  i^leasant,  not  rasjHng;  3d,  place  entire 
possibility  of  increase  and  decrease  of  current 
under  control  of  the  patient. 


46  DENTAL  PATHOLOGY 

What  unpleasant  results  may  follow  electricity  ? 

Ans.  May  paralyze  the  patient,  cause  tonic 
sj^asms,  etc. 

If  unpleasant  sequelae  follow  electricity,  how  are 
they  to  be  removed  ? 

Ans.  Keverse  the  current  by  changing  the 
poles. 

What  medicaments  are  recommended  for  gen- 
eral or  systemic  effect  in  reducing  sensitivity  of 
dentine  ? 

A71S.  Bi-meconate  of  Morphia,  Sulphate  of  Mor- 
phia, Opium,  Laudanum,  Paregoric,  Bromide  of 
Potassium,  etc.  Good  also  results  from  an  alterna- 
tion of  a  two  grain  asafoetida  pill  (sugar-coated) 
with  ten  to  twenty  drops  of  solution  of  the  Meco- 
nate  of  Morphia  (same  strength  as  Laudanum). 

How  are  they  to  be  administered  ? 

Ans.  Systemically,  by  small  doses. 

What  is  the  last  resort  ? 

Ans.  Produce  general  insensibility. 

How  is  it  effected  ? 

Ans.  By  partial  anaesthesia,  or  by  hypodermic 
injections. 

What  is  taught  of  the  safety  of  anaesthesia  ? 

Ans.  The  operator  must  understand  the  use  of 
the  agent  employed.  No  agent  which  in  a  minute 
or  two  can  produce  total  exemption  from  pain 
during  a  severe  operation  can  be  regarded  as  per- 
fectly safe. 


AXD   THERAPEUTICS.  47 


DEEP-SEATED    CARIES. 


"What  is  deep-seated  caries  ? 

Ans.  Where,  from  the  progress  of  decay,  the 
cavity  is  such  as  to  render  irritation  of  the  j^ulj) 
liable  during  excavating,  filling,  or  as  the  result  of 
the  operation. 

AVhat  is  the  general  condition  of  such  cavities  ? 

Ans.  They  are  full  of  debris,  decom2:)Osing  food, 
and  more  or  less  broken-down  "  tooth  structure." 

How  may  more  injury  than  benefit  be  inflicted? 

Ans.  By  removing  too  much  of  the  decalcified 
dentine. 

What  is  the  twofold  action  of  cavity  contents  ? 

Ans.  To  protect  i\\Q  pulp  from  thermal  changes, 
pressure,  etc. ;  also  to  hasten  decay,  by  giving  rise 
to  decomjiosition  of  organic  matter,  food,  etc.,  con- 
tained in  the  cavity. 

What  is  the  first  step  in  preparation  ? 

Ans.  Wash  out  the  cavity  with  tcjrid  water, 
gently  stir  or  loosen  with  a  blunt  j)robe  remaining 
debris,  and  wash  again ;  then,  if  indicated,  break 
down  enamel  edges,  so  that,  by  free  opening,  easy 
access  may  be  had  for  further  operations. 

What  is  to  be  especially  avoided? 

Ans.  Any  irritation,  shock,  or  coni2)ression  of 
the  pulp. 

How  should  such  cavities  be  syringed  ?• 

Ans.    Gently,   with   tepid  water,   directing   the 


48  DENTAL  PATHOLOGY 

stream  from  the  syringe  against  the  walls  of  the 
cavity,  rather  than  toward  the  pulp. 

Into  what  three  classes  are  such  washed  and 
dried  cavities  divided  ? 

Ans.  Those  containing  ivhite  decay,  yellowish, 
hroivnish,  and  blackish  decay ;  decay  of  horny  con- 
sistency. 

Give  some  peculiarities  concomitant  with  soft 
white  decay. 

Ans.  External  edges  almost  soft,  easily  broken 
down,  with  frequent  detachjnent  of  large  portions 
of  enamel  structure  with  slight  expenditure  of 
force;  the  decay  is  short-grained,  homogeneous, 
of  that  quality  which  permits  easy  removal  and 
ready  ingress  to  dangerous  proximity  to  pulp ; 
very  little  sensation  or  change  of  color  in  the 
dentine  as  the  pulp  is  approached. 

Give  the  peculiarities  concomitant  with  "  yellow- 
ish," "  brownish,"  and  "  blackish"  decay, 

Ans.  External  edges  are  of  varied  strength,  but 
all  are  reasonably  strong.  This  class  has  a  reason- 
able amount  of  warning  sensitiveness,  and  a  marked 
change  of  color  in  dentine  to  aid  our  knowledge  of 
the  probable  location  of  the  finest  extremities  of 
pulp-points. 

Give  the  peculiarities  concomitant  with  decay  of 
"  horny"  consistence. 

Ans.  The  decay  is  long-grained  and  tough ; 
great  caution  must  be  observed  to  "  lift"  and  "  cut" 


AND   THERAPEUTICS.  49 

such  decay  from  within,  out ;  if  improj^erly  cut  or 
lifted  from  ivitJiout,  in,  the  grain  runs  deeper  and 
deeper,  and  if  thoroughly  removed,  or  carelessly 
manipulated,  may  end  in  exposure  of  the  jxilp. 

What  is  taught  relative  to  conservation  of 
this  ? 

Ans.  Being  decalcified  dentine,  its  jDroper  and 
judicious  conservation  is  eminently  to  be  desired  as 
the  best  and  most  acceptable  pulp-capping  known, 

AVhat  of  its  medication?  What  governs  the 
appropriateness  of  medicaments  ? 

Ans.  The  decalcification  being  largely  due  to 
acid  action,  the  indications  are :  1st,  alkaline  treat- 
ment ;  2d,  simple,  soothing,  and  protecting  applica- 
tions ;  3d,  be  especially  careful  that  no  medicaments 
liable  to  coagulate  albumen  or  to  disorganize  or- 
ganic structure  are  ai^plied. 

What  considerations  govern  the  choice  of  filling 
materials  ? 

Ans.  Compatibility  with  tooth  structure,  tenuity 
of  the  walls,  and  thickness  of  dentine  overlying 
the  pulp ;  whether  these  will  bear  the  j^ressure  or 
proper  working  of  the  filling  material  to  be  intro- 
duced. 

What  governs  the  introduction  of  such  fillings  ? 

Ans.  Care  in  working,  direction  of  j^ressure ;  if 
painful,  stop  until  the  pain  ceases.  In  making 
hard  fillings,  pack  lightly  near  the  pulp,  increasing 
the  solidity  toward  the  surfa(*e. 


50  DENTAL  PATHOLOGY 

Besides  danger  from,  immediate  trouble,  what 
dangers  are  prospective  f 

Ans.  Irritation  from  thermal  changes,  prevention 
of  exudation  from  pulp,  absorption  or  liquefaction 
of  the  structure  between  the  pulp  and  filling  ma- 
terial, and  conditional  concomitants. 

How  are  pulps  covered  with  dentine  sometimes 
exposed  after  filling  such  cavities  ? 

Ans.  By  absorption  or  liquefaction  of  the 
film  of  dentine  between  the  pulp  and  filling 
material. 

How  are  pulps  sometimes  naturally  protected  ? 

Ans.  By  " recalcification,"  "tubular  consolida- 
tion," and  "  deposition  of  secondary  dentine." 

What  is  meant  by  "  tubular  consolidation"  ? 

Ans.  A  deposit  of  calcific  matter  in  the  dentinal 
tubuli,  obliterating  and  closing  their  calibre  and 
orifices.  This  deposition  takes  place  in  the  dentine, 
between  the  pulp  and  the  external  irritant. 

What  is  meant  by  deposition  of  secondary  den- 
tine? 

Ans.  At  the  point  of  irritation  the  pulp  exudes 
a  plasm,  which  in  the  process  of  time  becomes 
hardened  or  calcified. 

What  is  the  second  cause  of  odontalgia  ? 

Ans.  Slight  irritation  of  the  dental  pulp  before 
exposure,  and  when  nearly  exposed. 

What  five  classes  of  irritants  are  spoken  of  under 
this  head  ? 


AND    THERAPEUTICS.  51 

Ans.  Mechanical,  Cliemico-vital,  Vitiated  fluids 
of  the  mouth,  Thermal  changes,  and  Infiltra- 
tions. 

Give  examples  of  mechanical. 

Ans.  Impacting  of  food  or  other  material  ex- 
erting pressure. 

Give  examples  of  chemico- vital. 

A71S.  Putrescing  food,  decomj)Osing  seeds  of  fruit, 
berries,  and  the  like. 

What  is  the  sis-n  of  vitiated  fluids  of  the  mouth  ? 

Ans.  Viscidity,  or  "  spider-web"  appearance  of 
saliva. 

"What  teeth  are  most  liable  to  be  affected  by  cold 
air  in  the  upper  jaw  ? 

Ans.  Incisors  and  cuspids. 

Which  in  the  lower  jaw  ? 

Ans.  Incisors,  cuspids,  and  bicuspids. 

Which  is  generally  most  irritating,  hot  or  cold  ? 

A71S.  Cold. 

Why  ? 

Ans.  98  degrees  Fahrenheit  is  blood  heat ;  ice- 
water  is  about  60  degrees  lower,  and  can  be  easily 
and  even  comfortably  borne  in  the  mouth ;  hot 
drinks  or  liquids  above  140  degrees  can  scarcely  be 
endured,  and  have  a  difference  in  temperature  of 
but  little  more  than  40  degrees.  Therefore,  as 
possible  irritation  is  proportionate  to  variation  in 
temperature,  cold  can  be  more  intense  in  its  effects 
by  20  degrees. 


52  DENTAL   PATHOLOGY 

What  infiltrations  are  irritating  ? 

Ans.  Salt,  sweet,  and  sour. 

What  difference  exists  between  the  method  of 
such  irritation  in  sensitive  dentine  and  in  cavities 
of  deep  decay? 

Ans.  Irritation  of  sensitive  dentine  occurs  from 
pressure  of  food,  instrument,  finger-nail  contact, 
etc.  In  cavities  of  deep  decay  irritation  occurs 
from  simple  infiltration. 

What  are  the  symptoms  of  pulp  irritation  in 
such  cavities  ? 

Ans.  Uneasy  sensations,  positively  located,  great- 
est at  periods  of  recognized  irritation ;  no  sharj), 
paroxysmal  attacks,  no  increase  of  pain  upon  pres- 
sure of  tooth,  no  throbbing. 

What  is  meant  by  spontaneous  pain  ? 

Ans.  Pain  occurring  in  the  absence  of  any  tan- 
gible irritant. 

How  does  this  influence  prognosis  ? 

Ans.  It  is  decidedly  unfavorable,  being  indica- 
tive of  abnormality,  which  is,  as  a  rule,  beyond 
restoration  to  normality. 

What  is  taught  regarding  masses  of  decayed 
dentine  ? 

Ans.  From  the  stand-point  of  treating  and  saving 
the  pulps  of  poor  teeth,  it  becomes  obligatory  that 
a  sufficient  portion  of  the  decalcified  but  organic 
mass  should  be  allowed  to  remain  and  live  in  j^ro- 
tected  security. 


AXD   THERAPEUTICS.  53 

'What  pu/p  considerations  are  referred  to  in  this 
connection  ? 

uins.  It  refers  to  the  pulp  being  in  a  state  of 
health  or  disease,  the  probable  and  possible  recu- 
perative power  of  the  pulp,  together  with  various 
considerations  of  "  temperament,"  "  j^^^y^i^^^  ^^^~ 
dition,"  and  the  like,  which  may  have  a  bearing 
upon  these  points. 

What  two  objects  are  gained  by  conservation  of 
decayed  living  dentine  ? 

Ans.  1st,  prevention  of  exposure  and  undue 
approach  to  pulp ;  2d,  j^ossession  of  an  organized 
matrix  which,  being  "  protected,"  may  recalcify. 

Is  success  universal  under  such  treatment  ? 

Ans.  In  view  of  the  local  and  systemic  in- 
fluences which,  as  a  rule,  largely  negative  con- 
serving efforts  in  general,  as  well  as  in  dental 
practice,  it  may  not  be  positively  asserted  that 
success  uniformly  and  universally  follows  all  in- 
telligent and  well-directed  attempts ;  but  that  in 
the  large  majority  of  such  cases  (so  treated)  the 
active,  efficient,  and  beneficial  service  afterwards 
rendered  by  such  teeth  give  comfortable,  thankful, 
and  jiositive  assurance  as  to  the  propriety  and  ad- 
visability of  the  j^ractice  advocated. 

What  are  the  indications  of  success  ? 

Ans.  A  gradual,  and  more  or  less  decided  free- 
dom from  uneasiness  in  and  about  the  tooth,  few 
(if  any)  periods  of  "  recognized  irritation,"  even 


54  DENTAL  PATHOLOGY 

from  carelessness  or  forgetfulness  during  mastica- 
tion, biting,  thermal  changes,  and  the  like,  followed 
by  perfect  comfort  and  exemption  from  painful 
reminder  of  the  tooth. 

What  are  the  indications  of  danger  ? 

A71S.  Gradual,  growing  feeling  of  uneasiness, 
slightly  iyicreasing  response  to  cold,  increased 
thought  and  care  of  the  tooth  sometimes,  and 
undefined  apprehension  of  some  trouble  about  to 
result. 

What  are  the  symptoms  of  failure  ? 

Ans.  A  scarcely  j^erceptible,  yet  increasing  re- 
sponse to  heat,  occasional  pain,  neuralgic  trouble, 
nervous  exaltation,  and  systemic  sympathy  from 
reflex  action. 

What  is  taught  of  "  facial  neuralgia"  in  this 
connection  ? 

Ans.  "Slow  dying"  of  the  pulp  may  produce 
neuralgic  troubles  of  almost  every  grade,  intensity, 
and  duration.  The  "  twinges"  may  be  frequent 
or  infrequent,  decided,  severe,  exquisitely  painful, 
or  absolutely  torturing,  agonizing,  or  benumbing. 
If  the  seat  of  the  trouble  be  in  an  upper  molar 
or  biscuspid,  the  direction  of  the  pain  will  be 
from  the  tooth  u^Dward  about  the  temporal  region, 
backward  into  the  ear  and  head,  and  down  the 
neck. 

If  from  the  upper  canine  or  oral  teeth,  the  di- 
rection will  be  upward,  extending  over  the  lij). 


AND   THERAPEUTICS.  55 

cheek,  side  of  nose,  under  the  eye  and  deep  in  the 
socket ;  even  over  the  forehead  and  cranium.  If 
from  a  lower  molar,  the  direction  will  be  backward 
to  the  ear,  down  the  neck,  etc. 

The  pain  from  the  anterior  lower  teeth  is  more 
decidedly  localized  about  the  lip,  jaw,  chin,  anterior 
portion  of  neck,  etc.  The  salivary  glands  also 
appear  to  be  excited  to  excessive  secretion. 

What  are  the  possibilities  in  connection  with 
congestion  of  the  pulp  ? 

Ans.  The  effusions  may  be  absorbed,  and  the 
normal  tone  and  circulation  re-established.  It 
may  possibly  remain  in  a  chronic  congested  state 
without  giving  any  positive  trouble  for  an  indefinite 
2)eriod.  It  may  have  an  active  or  passive  death, 
and  become  j^utrescent,  or  it  may  mummify,  all 
such  possibilities  being  controlled  or  modified  by 
temperament,  age,  systemic  influence,  etc. 

What  is  the  summary  of  causes  of  irritation  in 
deep-seated  caries  ? 

Ans.  1st,  vitally,  by  irritating  and  escharotic 
applications ;  2d,  mechanically,  by  excavating ; 
3d,  by  pressure,  such  as  results  from  plugging; 
4tli,  by  conduction,  or  other  irritation  after  plug- 
ging, such  as  results  from  a  blow,  biting  pieces  of 
ice,  etc. 

What  is  the  summary  of  remedies  ? 

Avs.  First.  Judicious  apj^lication  of  medica- 
ments, and  the  proper  protection  of  the  pulji  from 


56  DENTAL  PATHOLOGY 

tlie  action  of  sucli  medicines  as  may  possibly  or 
are  likely  to  cause  irritation. 

Second.  Care  in  excavating,  and  accurate  knowl- 
edge of  pulp  cavities. 

Third.  Using  lateral  pressure  in  plugging,  jDroper 
and  judicious  packing  of  foil  or  other  material, 
interposition  of  solid  base  which  may  sustain 
unavoidable  pressure,  and  the  use  of  plastic  fill- 
ings. 

Fourth.  Interposition  of  non-conducting  or  po- 
rous intermediate  filling. 

What  are  the  gradations  from  "  deep"  decay 
to  exposure, — two  or  three  ? 

Arts.  Three.  1st,  very  deep  decay ;  2d,  nearly 
exposed ;  3d,  quite  exposed  ^vl^. 

Are  these  always  of  equal  im^Dort  ? 

Ans.  They  are  not. 

Why? 

Ans.  "  Deep"  decay  in  the  nervo-lymphatic 
tooth  Avould  call  for  all  the  care  and  skill  required 
in  an  almost  exposed  pulp  of  a  nervo-sanguine 
tooth,  and  the  comparatively  simple  "nearness 
of  decay  to  |)^^lp"  of  the  bilio-lymphatic  com- 
pares with  "  absolute  exposure"  in  the  bilio-san- 
guine. 

AVhat  are  the  eight  controlling  influences  in  con- 
servation of  pulp  ? 

Ans.  Age,  barometric  and  thermal  changes, 
temperament,  sex,  j)lace  of  residence  and  mode  of 


AND   THERAPEUTICS.  57 

living,  2>liysical  condition,  over-exertion,  and  occu- 
pation. 

To  what  time  of  life  does  age  refer  ? 

Ans.  Youth,  maturity,  and  old  age.  Each  of 
these  are  again  subdivided  into  very  marked  peri- 
ods of  comparative  cessation  from  decay.  The 
first  twenty  years  of  life  are  most  marked  with 
trouble :  systemic,  as  in  the  bones  and  various 
organs;  local,  as  markedly  exhibited  in  decay, 
inq^erfect  calcification  of  the  teeth,  etc. 

What  is  the  first  division  of  "  temj^eraments"  ? 

Ans.  Four  basal  temperaments, — Bilious,  San- 
guine, Lymphatic,  and  Nervous. 

What  is  the  second  division  of  twelve  temj)era- 
ments  ? 

Ans.  1st,  Sanguo-bilious,  Lymphatico-bilious, 
Nervo-bilious ;  2d,  Bilio-sanguine,  Lymphatico- 
sanguine,  Nervo-sanguine ;  3d,  Bilio-lymphatic, 
Sanguo-lymphatic,  Nervo-lymphatic ;  4th,  Bilio- 
nervous,  Sanguo-nervous,  Lymphatico-nervous. 
This  is  called  the  "  dual"  division. 

Into  what  two  classes  are  temperamental  attri- 
butes divided? 

A71S.  Internal  and  External. 

What  are  the  external  attributes  of  teeth  of  the 
Bilious  temperament  ? 

Ans.  Slightly  narrow  at  the  necks,  almost  the 
same  size  from  necks  to  cutting  edge,  yellowish  in 
color,  strongly  fixed  in  the  jaw,  strong  enamel,  etc. 


58  DENTAL  PATHOLOGY 

A¥hat  are  the  external  attributes  of  the  Sanguine? 

Ans.  Dense  structure,  strongly  fixed  in  the  jaw, 
beautiful,  translucent,  light  to  dark  cream  color,, 
crowns  appear  shorter  than  other  teeth ;  of  the 
same  size  from  neck  to  cutting  edge,  "horseshoe" 
arch,  worn  cutting  edges. 

What  are  the  external  attributes  of  the  Lym- 
phatic ? 

Ans.  Large  and  "  bulky,"  thick  necks  and 
cutting  edges,  and  bulging  in  the  body ;  not 
strongly  fixed  in  the  jaw;  of  a  white  or  whitish 
yellow,  pallid  color. 

What  are  the  external  attributes  of  the  Nervous  ? 

Ans.  Narrow  at  the  necks,  and  increasing  in  size 
to  the  cutting  edges ;  long,  brilliant  in  color,  from 
a  pearly  white  to  a  bluish  white ;  fine,  sharp  cusps, 
fully  formed,  and  seldom  worn ;  presenting,  as  a 
whole,  a  bright  and  j)leasing  appearance. 

What  are  the  internal  attributes  of  the  Bilious  ? 

Ans.  Strength,  permanence,  endurance,  ca^Da- 
bility,  persistence ;  good  and  determined  recupera- 
tion. 

What  are  the  internal  attributes  of  the  San- 
guine ? 

Ans.  Volume  of  nutrition,  reliable  recuperation 
from  molecular  to  systemic ;  dense  structure. 

What  are  the  internal  attributes  of  the  Nervous  ? 

Ans.  Comparatively  dense  structure,  good  or- 
ganization, lacking  perfect  solidity  ;  quickness  and 


AND    THERAPEUTICS.  59 

frequency  of  recuperation  and  resistance  rather 
than  reliahility  and  permanence, 

AVhat  are  the  internal  attributes  of  the  Lym- 
pliatic  ? 

An><.  Bulky,  looseness  of  structure  and  tissue, 
tending  more  toward  feebleness,  lacking  in  strength ; 
tardy  and  feeble  of  recuperation ;  degeneration  and 
relapse  is  liable. 

From  what  three  stand-points  are  the  internal 
attributes  considered  ? 

Ans.  General  innervation,  circulation,  and  nu- 
trition. 

What  is  the  grouping  of  temperaments  for  dental 
study  called  ? 

Ans.  Dento-Temperamental. 

Into  how  many  classes  are  temperaments  divided 
dentally  ? 

Ans.  Into  four. 

Name  the  first  class. 

Ans.  Bilio-sanguine,  Sanguo-bilious. 

Name  the  second  class. 

Ans.  Lymphatico-sanguine,  Lymphatico-bilious, 
Nervo-bilious,  xservo-sanguiue. 

Name  the  third  class. 

Ans.  Sanguo-lymphatic,  Bilio-uervous,  Sanguo- 
uervous,  Lymphatico-nervous. 

Name  the  fourth  class. 

Ans.  Bilio-lymphatic,  Nervo-lymphatic. 

AVhat  are  the  characteristics  of  the  first  class  ? 


60  DENTAL  PATHOLOGY 

A71S.  "  Excellent." 

What  are  the  characteristics  of  the  second  ? 

Ans.  "Good." 

"What  of  the  third  ? 

Ans.  "  Doubtful  and  anxious.^^ 

The  fourth? 

Ans.  Positively  "  diabolical." 

If  Sanguo-bilious  follows  Bilio-sanguine,  why 
does  not  Sanguo-lymphatic  follow  Lymphatico- 
sanguine  ? 

Ans.  Because  of  a  difference  in  basal  attributes, 
the  sanguine  base  giving  strength,  volume  of 
nutrition,  hopeful  recuperation,  etc.,  to  the  Lym- 
phatico-sanguine  temperament.  The  Lymj)hatic 
base,  on  the  contrary,  being  slow,  bulky,  feeble, 
and  lacking  both  in  reliable  recuperation  and  good 
nutrition,  naturally  gives  place  to  a  temperament 
with  stronger  basal  attributes.  The  Bilio-sanguine 
and  the  Sanguo-bilious  being  strong  in  the  basal 
and  modifying  attributes,  they  properly  follow  in 
regular  order. 

In  what  manner  does  "  physical  condition"  in- 
fluence pulp  conservation  ? 

Ans.  Even  though  temperamental  attributes  be 
good,  if  the  system  is  dej^ressed  from  any  cause  the 
vital  force  of  pulps  is  diminished,  and  response  to 
ordinary  medication  is  in  consonance  with  the  dis- 
ordered physical  condition.  It  is  often  the  case, 
however,  that  pulps  grading  low  (as  regards  tem- 


AXD   THERAPEUTICS.  61 

perameiital  attril)iites)  give  decided  and  enconr- 
agiiig  response  when  their  possessors  are  in  vigorous 
heahh. 

How  does  "  over-exertion"  act  upon  it  ? 

Ans.  Over-exertion  directly  lowers  vitality,  not 
only  of  the  whole  body,  but  of  every  cell ;  pulps 
are  thus  indirectly  affected,  become  unable  to  resist 
the  advance  of  caries,  weaken,  fail,  and  die.  This 
is  especially  marked  in  individuals  of  an  anaemic, 
low-grade  temperament. 

In  what  manner  does  "  sex"  influence  it  ? 

Ans.  Failure  in  both  sexes  is  about  the  same, 
yet  at  certain  periods  sex  appears  to  markedly 
influence  {negatively)  preservation  of  pulps  and 
teeth. 

How  does  pregnancy  affect  it  ? 

A71S.  Pregnancy  appears  to  have  a  decided  and 
adverse  influence. 

In  what  manner  does  "  occui:>ation"  influence  it? 

Ans.  Sedentary  employment,  lack  of  ventilation, 
imperfect  drainage,  changes  of  temperature,  etc., 
together  with  depressed  mind,  weakened  physical 
condition,  etc.,  exert  an  adverse  control.  In  fact, 
anvthino-  tendins;  to  lower  o-eneral  vital  force, 
either  directl}^  or  indirectly,  diminishes  the  proba- 
bility of  recuperation  and  response  on  the  part 
of  pulps. 

How  does  "  mode  of  livino'"  act,  beneficiallv  or 
prejudicially? 


62  DENTAL  PATHOLOGY 

Ans.  If  mode  of  living  is  improper,  if  a23petite 
is  improperly  indulged,  or  if  food  is  insufficient 
and  of  poor  quality,  clothing  scanty,  etc.,  the  sys- 
tem will  be  deranged,  vitality  lowered,  and  pulps 
give  little  response  to  local  conservative  treatment. 
On  the  contrary,  if  all  such  conditions  be  reversed, 
the  conditions  for  conservative  treatment  of  the 
pulp  in  any  individual  (modified  by  temperament) 
are  alike  most  favorable. 

What  is  taught  regarding  influences  of  location 
or  j)lace  of  residence  ? 

Ans.  Persons  residing  in  localities  where  malaria 
is  present  are  weakened  and  depressed  by  its  influ- 
ence. In  such  persons  disease  tends  to  the  periodic 
type.  Therefore  conservative  treatment  under  such 
conditions  is  uncertain  and  often  fails.  It  has  been 
observed  where  pulps  have  been  capped  in  healthy 
localities,  and  the  patients,  by  change  of  residence, 
have  been  afterwards  subjected  to  the  influence  of 
malaria,  that  serious  trouble,  and  often  death  of 
such  pulps,  frequently  followed. 

What  is  taught  regarding  "  thermal"  influences, 
either  local  or  general  ? 

Ans.  Local  applications,  such  as  hot  or  cold 
food,  cold  liquids,  cold  air,  etc.,  produce  injurious 
efiects  upon  pulps  in  proportion  as  the  latter  are 
approached  by  caries,  chemical  abrasion,  or  other 
agencies.  Changes  of  temperature  alternately  en- 
large and  constringe  the  superficial  blood-vessels, 


AXD   THERAPEUTICS.  63 

and  thus  dispose  to  congestions,  fluxes,  and  inflam- 
uiations,  which  impair  tonicity  and  vitality.  Tliis 
perversion  of  the  circulation  gives  rise  to  general 
systemic  derangement,  which  is  adverse  to  pulp 
conservation. 

How  do  "barometric"  changes  influence  pulp 
conservation  ? 

Ans.  As  a  rule,  the  influence  of  barometric 
changes  is  exciting.  March  and  November  in  this 
climate  are  unfavorable  months  for  conservative 
treatment  because  of  barometric  changes. 

What  is  the  third  cause  of  odontalgia  ? 

Ans.  Irritation  of  the  dental  pulp  from  "almost" 
or  "  complete"  exposure  ;  dying  pulp. 

AVhat  are  the  symptoms  ? 

Ans.  Paroxysmal  and  remittent,  or  intermittent 
pain ;  not  periodic,  not  always  positively  located ; 
very  severe  during  paroxysms,  throbbing  or  jump- 
ing; great  exacerbation  from  thermal,  vital,  or 
iiiechanical  irritation ;  greater  at  times,  generally 
during  the  night ;  no  increase  of  pain  from  pres- 
sure, but  sometimes  from  concussion. 

What  are  the  six  heads  under  which  liability  to 
irritation,  i^rior  to  filling,  are  discussed  ? 

Ans.  1st,  infiltration  of  sweet  or  sour ;  2d,  direct 
contact  with  foreign  bodies ;  3d,  j^ressure  of  bodies ; 
4th,  thermal  irritation  ;  5th,  mechanical  irritation  ; 
6th,  medicinal  applications. 

What  is  the  first  and  most  important  knowledge 


64  DENTAL  PATHOLOGY 

needed  for  diagnosing  almost  exposed  or  exposed 
pulps  ? 

Ans.  Anatomical  peculiarities  pertaining  to  pulp- 
cavities.  Their  position,  extent,  general  direction, 
and  depth  of  covering  (normally)  of  the  cornua ; 
the  joortion,  or  portions  of  pulp  which  are  (nor- 
mally) most  accessible,  and  which  lie  nearest  to 
the  surface,  etc. 

What  is  taught  in  regard  to  the  pulp-cavity 
being  a  miniature  of  the  crown  of  the  tooth  ? 

A71S.  That  it  is  always  a  miniature  is  not 
true,  except  in  a  ge7ieral  way.  The  cornua  of 
j)ulps  are  sometimes  elongated,  sometimes  short- 
ened. 

What  is  taught  in  regard  to  the  relative  position 
of  the  pulp-cavities  in  teeth  in  the  hand  and  in 
teeth  in  the  mouth  ? 

Ans.  Teeth  in  the  jaw  never  have  that  upright 
position  given  in  diagrams,  or  usual  in  manual 
examinations,  and  sometimes  are  not  in  direct 
apposition  with  each  other.  Therefore,  as  their 
surroundings  and  position  have  much  to  do  with- 
a  correct  understanding  in  this  regard,  a  full  ap- 
2)reciation  must  be  had  of  teeth  in  both  positions, 
in  order  that  a  thorough  application  of  such  knowl- 
edge may  be  practically  applied. 

What  four  considerations  obtain  in  relating 
cavities  of  decay  with  exposure  of  pulps  ? 

Ans.  1st,  situation  of  cavity  of  decay  ;  2d,  depth 


IjOPt 


AXD    THERAPEUTICS.  65 

of  the  cavity :  3d,  direction  of  the  cavity ;  4th, 
character  of  the  caries. 

What  are  the  fo^it'  means  of  diagnosing  almost 
exposed  or  exposed  pulps  ? 

Ans.  1st,  heat  and  cold  :  2d,  vision  ;  3d,  pressure 
by  pellets  :  4th,  taxis. 

PULP    CAPPING. 

What  are  the  first  considerations  ? 

Ans.  Whether  chances  are  in  favor  of  any  effort 
to  be  made  toward  conservation,  and  whether  the 
increased  skill  required  to  meet  even  a  diminished 
likelihood  of  success  is  possessed. 

What  are  taught  as  the  governing  influences  in 
pulp  conservation,  good  material  for  capping  and 
proper  manipulation  conceded  ? 

Ans.  Condition  of  the  pulp,  temperament,  age, 
systemic  condition,  etc.,  have  their  governing 
influence,  and  must  be  considered  in  deciding  the 
g-radt'  of  exertion  warranted  in  any  individual  case. 

What  are  the  seven  desirable  attributes  for  cap- 
ping material? 

A 11^.  Xon-conductivity,  Xon-irritating,  Porosity, 
Plasticity,  Resisting  capability.  Durability,  and  the 
advantage  of  healing  or  soothing  attributes,  with 
compound  or  simple  applications. 

Name  a  few  materials  which  are  used  as  judp- 
protectors. 

Ans.  Oxysulphate  of  Zinc,  Gutta-percha.  Var- 


QQ  DENTAL  PATHOLOGY 

nislies,  Oil  of  Cloves  Pad,  Plaster  of  Paris,  Lacto- 
phospliate  of  Lime,  Arnica  Court-plaster  (water- 
proof), Cork,  Goldbeaters'  Skin,  Quill,  Ivory,  Tin 
Foil,  Tliin  Lead  Plate,  Oxycliloride  of  Zinc,  Hy- 
drated  Oxychloride, 

What  is  taught  regarding  gutta-percha  as  a 
capper  ? 

Ans.  It  is  one  of  the  standard  applications ;  is 
non-irritating  if  properly  applied,  non-conducting, 
in  harmony  with  tissue  and  tooth  structure,  easily 
adapted,  sufficiently  resisting,  and  may  be  con- 
sidered good. 

What  of  oxycliloride  of  zinc  ? 

Ans.  It  is  irritating  and  escharotic  if  applied  in 
excess  ;  has  many  good  points,  and  there  may  have 
been  many  cases  where  its  application  as  a  pidp 
capper  has  been  productive  of  Just  sufficient  irri- 
tation of  pulp  to  result  in  good.  But  as  there  is 
at  j)resent  no  known  possible  method  by  which  to 
determine  the  probable  exact  degree  of  irritation 
resulting  from  the  application  of  a  certain  quantity 
in  individual  cases,  it  is  deemed  wise  to  reject  it 
for  this  special  purpose. 

What  of  hydrated  oxychloride  of  zinc  ? 

Ans.  In  some  cases  it  may  be  very  good,  and  is 
less  irritating  than  the  pure  oxychloride ;  but  as 
other  materials  are  better  in  many  respects,  it 
becomes  simply  a  matter  of  prudence  as  regards 
its  use. 


AXD   TIIEnAPEUriCS.  07 

What  of  lacto-phospliate  ? 

Ans.  It  is  regarded  as  acceptable  to  pulp  struc- 
ture. Three  ingredients  enter  into  its  composi- 
tion :  1st,  magma-phosphate  of  lime  (moist)  ;  2d, 
Merck's  lactic  acid ;  3d,  powdered  phosphate  of 
lime  (dry). 

What  of  zinc-phosj^hate  ? 

Ans.  When  the  peculiar,  slow,  but  fer-reaching 
and  destructive  action  of  phosj^horic  acid  is  con- 
sidered, together  with  the  fact  that  most  z'inc- 
phosj^hates  after  mixing  have  an  acid  taste  and 
reaction,  their  use  may  be  termed  questionable. 

What  of  oxysulphate  of  zinc  ? 

Ans.  It  is  about  the  best  ca2:>23er  for  general  use 
that  we  have ;  is  easily  adapted,  even  in  inaccessi- 
ble cavities ;  sets  quickly  and  sufficiently  hard ;  is 
non-irritating  and  non-conducting ;  porous,  plastic, 
and  in  harmony  alike  with  tooth  structure  and 
pulp-tissue. 

What  length  of  time  is  taught  as  "  probationary" 
prior  to  deciding  whether  efforts  at  pulp  saving 
are  successful  ? 

Ans.  From  six  months  to  a  year. 

Is  this  length  of  time  universally  reliable  ? 

Ans.  It  is  not,  for  pulps  may  give  symptoms  of 
failure  in  less  time,  and  may  not  do  so  for  years. 

What  is  taught  regarding  teeth  the  pulps  of 
which  die  lino-erino-  deaths  ? 

Ans.  A  tooth  in  which  the  pulp  has  died  a  "  lin- 


68  DENTAL  PATHOLOGY 

gering  death"  does  not  last  so  long,  and  is  more 
liable  to  give  trouble  in  the  future  than  a  tooth  in 
which  the  pulp  has  been  quickly  devitalized. 
Long-continued  pain,  alteration  of  the  circulation 
and  alteration  of  nutrition  in  and  about  the  tooth 
and  contiguous  tissues  results  in  the  establishment 
of  a  decided  adverse  impress,  which,  upon  the  ap- 
plication of  an  exciting  cause,  develops  with  more 
or  less  celerity  and  intensity.  A  tooth  which  has 
not  been  subjected  to  such  long-continued  depress- 
ing and  predisposing  influences  permits  (after 
death  of  pulp)  of  a  more  perfect  re-establishment 
of  comparative  normality. 

What/owr  considerations  contra-indicate  efforts 
at  pulp  conservation  ? 

Ans.  1st,  when  pulps  give  decided  evidence  of 
marked  irritation,  with  a  probable  future  of  no 
relief;  2d,  when  the  person  is  sick,  systemic  con- 
dition is  poor,  and  they  are  unable  to  bear  any 
additional  pain ;  3d,  when  freedom  from  future 
trouble  (possible  from  death  of  pulp)  is  desired ; 
4th,  when  time  cannot  be  allowed  for  conservative 
treatment,  devitalize. 

Name  the  ten  means  of  external  irritation  to 
pulps. 

Ans.  Infiltration  of  salt,  sweet,  or  sour  condi- 
ments ;  direct  contact  with  foreign  bodies ;  pres- 
sure of  foreign  material ;  thermal  irritation ;  me- 
chanical  irritation ;    medicinally ;    prevention   of 


AND   TIIEEAPEFTICS.  GO 

exudation  by  filling ;  loss  of  tooth  substance  from 
attrition  ;  fracture  of  tootli ;  disease  of  surrounding 
parts. 

What  is  the  internal  cause  of  irritation  ? 

Ans.  Pulp-nodules. 

How  is  the  absorj^tion  of  permanent  roots  diag- 
nosed ? 

Ans.  Pain  is  neuralgic  ;  located  about  the  cheek 
(which  at  times  is  tender  when  pressed),  in  the 
eye,  etc. ;  great  j)ain  from  hot  or  cold  ap2:)lications ; 
sometimes  a  peculiar  2)ricking  sensation  from  j^ress- 
ing  the  tooth,  and  decided  resj^onse  from  tapping 
or  striking  it.  The  teeth,  as  a  rule,  are  good  and 
strong  as  regards  their  structure,  and  are  firmly 
set  in  their  sockets. 

What  is  "  nodular  calcification"  ? 

A71S.  It  consists,  practically,  in  the  formation  of 
small  nodules  of  calcified  matter  within  the  pulp- 
tissue  ;  is  generally  confined  to  the  body  of  the 
pul]),  but  at  times  nodules  are  found  within  the 
pulp-canals. 

What  is  the  recognized  connection  between  ab- 
sorption of  permanent  roots,  or  nodular  calcifica- 
tion, and  dental  caries? 

Ans.  Absorption  occurs  in  teeth  the  crowns  of 
which  are  sound  and  symmetrical.  Nodular  calci- 
fication occurs  in  the  pulps  of  teeth  the  crowns  of 
which  are  also  perfect  in  every  respect.  Therefore, 
even  though  decay  may  be,  and  often  is,  found  in 


70  DENTAL  PATHOLOGY 

connection  with  such  teeth,  it  cannot  be  claimed  to 
have  a  cause  and  effect  relation  to  either  of  the 
above  conditions. 

What  is  taught  regarding  comi:)lete  extraction  in 
these  cases  ? 

An8.  Every  portion  of  root  must  be  extracted, 
otherwise  very  little,  if  any,  relief  will  be  afforded. 

What  is  the  underlying  jDrinciple  which  governs 
practice  in  the  treatment  of  irritation  from  pulp- 
nodules  ? 

An§,.  The  utmost  care  and  caution  is  required, 
that  a  steady  advance  toward  the  pulp  may  be 
made  with  the  least  possible  irritation. 

What  are  the  sym2:>toms  of  pulp-nodules  ? 

An8.  Enamel  is  sensitive,  and  responds  to  touch. 
Striking  or  tapping  the  tooth  elicits  painful  re- 
sponse. The  character  of  the  pain  may  be  con- 
tinued or  intermittent,  and  become  more  violent  as 
the  abnormal  condition  continues,  or  is  influenced 
by  the  system,  etc.  Generally  the  gum  and  health 
line  have  the  normal  ajDpearance ;  usually  the  den- 
tine is  highly  sensitive  (though  at  times  this  is  not 
met  with)  ;  the  pulp  just  previous  to  and  upon  ex- 
posure is  extremely  sensitive  to  pressure. 

How  is  diagnosis  of  this  condition  made  ? 

Aiu.  From  symptoms  alone. 

What  influence  has  temperament  and  physical 
condition  in  connection  with  jDulp-nodules  ? 

An8.  Nodular  calcification   is  seldom  found  in 


AND    THERAPEUTICS.  71 

connection  with  low-grade  temperamental  attri- 
butes and  weakened  system ;  high-grade  tempera- 
ments, such  as  Sanguo-bilious,  Lymphatico-san- 
guine,  Nervo-sanguine,  and  the  like,  are  more  liable 
to  it  on  account  of  sthenic  irritation  and  the  power- 
ful recuperative  and  protective  efforts  of  vital  parts. 

What  is  the  preliminary  treatment  ? 

Ans.  Administration  of  Asafoetida  in  pill  form, 
and  Solution  of  Meconate  of  Mor^Dliia ;  local  apj^li- 
cation  of  Aconitia  Ointment  (Aconitia  two  grains, 
simj^le  cerate  one  drachm),  followed  by  Ointment 
of  Veratria  (Veratria  one  scruj^le,  simple  cerate  one 
drachm).  Use  in  very  small  portions  (about  size 
of  common  pin-head) .  Rub  gently  over  the  eyes, 
temples,  sides  of  the  nose,  and  about  the  cheeks. 
Be  very  careful  not  to  get  ointment  into  the  eyes. 

What  of  the  entrance  to  pulps  in  such  teeth  ? 

Ans.  This  should  be  effected  with  the  utmost 
care.  For  obtunding  sensitive  dentine,  use  Chromic 
Acid,  Arsenical  Paste,  Chloride  of  Zinc,  Electricity, 
etc.    For  devitalizing  the  puljD,  use  Arsenical  Paste. 

What  is  "  phantom  odontalgia"  ? 

Ans.  It  is  that  form  of  odontalgia  which  has  its 
origin  in  a  location  from  which  a  tooth  or  teeth 
have  been  extracted. 

What  is  the  best  method  for  curing  this  ? 

A71S.  Using  a  medium-sized  round  or  oval  bur, 
drill  into  the  socket,  and  thoroughly  lacerate  the 
tissue  at  the  bottom.    After  washing  and  cleansing 


72  DENTAL  PATHOLOGY 

the  parts,  apply  Aconite  and  Morj^hia  Paste.  Sys- 
temic medication  may  also  be  considered  in  obsti- 
nate cases. 

How  is  a  fungous  growtli  of  gum  within  a  tootli 
diagnosed  at  once  from  that  of  a  fungous  pulp  ? 

Ans.  This  cannot  be  done ;  it  requires  time  and 
treatment  before  a  correct  diagnosis  can  be  given. 

What  is  the  first  treatment  for  both  ? 

Ans.  Soothing,  absorbent,  astringent. 

Why? 

Ans.  Because  you  cannot  be  assured,  at  first,  as 
to  whether  it  is  hypertrophied  gum  or  j^ulp-tissue. 
Therefore,  to  be  2wsitively  assured  as  to  the  true 
condition,  such  treatment  must  be  followed  as  shall 
tend  to  reduce  the  enlargement  sufiiciently  to  per- 
mit of  satisfactory  diagnosis  as  to  its  origin. 

COMPLICATED    CARIES. 

What  is  complicated  caries  ? 

A71S.  That  stage  of  decay  connected  with  a  pulp- 
less  tooth,  or  which  requires  for  its  successful  treat- 
ment the  devitalization  and  extirpation  of  the  dental 
jDulp. 

Is  a  pulpless  tooth  a  dead  tooth  ? 

Ans.  It  is  not  as  regards  the  cementum  and 
pericementum ;  it  is  when  reference  is  had  to  the 
enamel  and  dentine. 

Why? 

Ans.    The  vital    and   nutrient   forces,  supplied 


AND    THERAPEVTICS.  73 

through  the  pulp  to  the  dentine  and  enamel,  are 
entirely  cut  off  from  these  structures  u2)on  death  of 
the  pulp.  As  the  cementum  is  nourished  by  the 
peridentium,  and  it  in  turn  by  proper  nutrient 
vessels,  they  still  live  after  death  of  the  pulp. 

What  are  the  various  functions  of  the  dental 
pulp  ? 

Ans.  A  means  of  nutrient  supply,  sensation, 
jn'eservation  of  translucency,  vital  resistance,  etc. 

What  are  the  probabilities  of  a  pulj^less  tooth? 

Ans.  The  probabilities  of  a  j^uljiless  tooth  are 
graded  according  to  the  temperament,  occuj^ation, 
and  general  physical  condition  of  the  individual. 
For  example :  if  all  things  are  encouraging,  then 
a  favorable  i~>rognosis  in  regard  to  the  future  com- 
fort of  the  tooth,  its  future  service,  and  the  like, 
may  be  given.  In  this  connection  it  must  be  re- 
membered that  overwork  in  relation  to  the  tooth 
itself  is  a  powerful,  exciting,  and  jiredisposing 
cause  to  disease.  Therefore  the  position  of  the 
tooth,  and  the  amount  of  work  it  is  ex23ected  to 
do,  should  be  carefully  considered. 

What  are  the  possibilities  of  a  pulpless  tooth? 

Ans.  The  possibilities  of  a  pulpless  tooth  cannot 
be  graded,  as  we  are  unable  to  determine  the 
amount  and  duration  of  vital  resistance  a  peri- 
dental membrane  will  successfully  offer  under  the 
various  altered  conditions  to  which  it  may  be  in 
turn  subjected.     Therefore  the  possibilities  include 


74  DENTAL  PATHOLOGY 

most  of  the  comparatively  normal  and  diseased 
conditions  usually  found  in  connection  with  pulp- 
less  teeth.  For  instance :  under  adverse  influences 
such  a  tooth  may  remain  quiescent  and  compara- 
tively comfortable  for  an  indefinite  period ;  again, 
under  the  most  hopeful  auspices,  it  may  be  pro- 
ductive of  so  much  affliction  as  to  necessitate 
removal. 

What  are  the  four  means  of  devitalizing  a  j^ulp  ? 

Ans.  Luxation,  the  twisting  or  loosening  of  a 
tooth  in  its  socket ;  Devitalization  with  approjDriate 
medicament ;  Extir23ation,  or  Broaching  and  Punc- 
turing ;  Actual  Cautery. 

What  is  "puncturing,"  and  with  what  appli- 
ances, instrumental  and  medicinal,  and  how,  is  it 
done? 

Ans.  Puncturing  consists  in  devitalizing  the 
pulp  by  means  of  instrumentation.  A  straight 
instrument,  tapering  to  a  fine  and  extremely  sharp 
point,  is  used  ;  delicacy  of  manipulation  is  essential, 
as  by  repeated,  gentle,  and  gradually  advancing 
thrusts,  aided  by  obtunding  applications  of  the 
Dental  Tincture  of  Aconite,  Acetate  of  Morphia 
Paste,  Arsenious  Acid,  etc.,  progress  is  made  and 
vitality  destroyed. 

What  is  Arsenious  Acid,  and  from  what,  and 
how,  is  it  obtained  ? 

Ans.  Arsenious  Acid  is  an  oxide  of  the  metal 
Arsenic.    It  is  obtained  by  burning  Arsenic  in  the 


AND   THERAPEUTICS.  75 

open  air ;  the  oxide  is  formed,  rises  in  vapor,  and 
is  condensed  in  the  flues  of  the  chimney.  It  is  a 
violent  poison,  condenses  in  octahedral  crystals,  by 
which  it  may  always  be  recognized.  It  is  not  very 
soluble  in  water ;  very  soluble  in  alkaline  solutions  ; 
has  a  feeble  acid  reaction ;  forms  arsenites ;  has  a 
feeble,  sweetish,  rough  taste. 

Give  three  or  four  tests  for  arsenic. 

Ans.  Ammoniacal  Nitrate  of  Silver  gives  with 
arsenious  acid  a  yellow  arsenite  of  silver. 

The  jDroduction  of  arseniuretted  hydrogen,  by 
using  Marsh's  aj^paratus,  and  allowing  the  burning- 
jet  to  impinge  on  a  cold,  white  porcelain  surface. 
The  brownish-black  spot  is  deposited ;  or  by  heat- 
ing the  glass  tube  through  which  the  gas  is  j^assing, 
the  characteristic  riny  is  deposited  just  in  advance 
of  the  heated  portion.  The  blow-pij)e  test  gives  a 
garlic  odor.  If  there  is  an  unsublimed  residuum 
the  arsenic  is  impure. 

Eeinsch's  test :  Macerate  the  suspected  tissue  in 
water;  add  one-tenth  bulk  of  fluid  hydrochloric 
acid,  and  boil  for  half  an  hour  with  bright  copper 
foil ;  if  arsenic  be  present  the  copj^er  will  have  a 
gray  metallic  crust. 

Who  introduced  arsenious  acid  in  dental  practice? 

Ans.  Dr.  J.  E.  Sj^ooner,  of  Montreal. 

What  is  the  date  of  its  introduction  ? 

Ans.  It  was  made  known  by  his  brother.  Dr.  S. 
Spooner,  in  1836. 


76  DENTAL  PATHOLOGY 

What  is  the  solubility  of  white  oxide  of  arsenic 
in  creasote,  carbolic  acid,  and  oil  of  cloves  ? 

Ans.  Insoluble  in  all. 

What  is  taught  regarding  arsenical  irritation 
through  a  normal-sized  apical  foramen  in  a  fully 
formed  tooth  ? 

Ans.  There  can  be  no  irritation  in  surrounding 
tissue  through  such  a  foramen  unless  the  arsenic  is 
forced  through. 

AVhat  of  the  j^robabilities  in  not  fully  formed 
teeth  ? 

Ans.  Such  irritation  may  be  produced  if  the 
application  is  allowed  to  remain  too  long,  or  is 
often  repeated.  Caution  should  be  observed  in 
connection  with  its  use  in  children's  teeth. 

What  regarding  the  length  of  time  needful  and 
possible  for  arsenical  applications  ? 

Ans.  No  positive  time  may  be  given,  but  usually 
from  two  to  twenty-four  hours ;  sometimes  by 
merely  placing  the  arsenic  in  the  tooth  and  taking 
it  out  again  ;  possibly  a  year. 

What  regarding  cause  and  treatment  of  any 
peridental  irritation  which  supervenes  upon  ar- 
senical devitalization  ? 

Ans.  Cause. — The  separation  between  living  and 
dead  tissue  immediately  beyond  the  apical  fora- 
men, also  consequent  diversion  of  the  normal 
circulation,  particularly  to  the  peridental  mem- 
brane, is  productive  of  determination,  etc.,  with 


AND   THERAPEUTICS.  77 

concomitant  exalted  vitality,  tenderness,  and  the 
like.     • 

Treatment. — As  a  rule,  the  vital  force  of  the 
parts  is  sufficient  to  re-establish  comparative  nor- 
mality in  a  short  space  of  time;  when  the  ten- 
derness continues  or  increases,  2:>roper  soothing 
antiphlogistic  or  stimulating  apj^lications  should 
be  made  to  the  gum,  as  indicated  by  the  signs 
and  symptoms. 

What  are  the  three  forms  of  arsenical  applica- 
tions ? 

Ans.  Arsenical  Paste,  Devitalizing  Fibre,  and 
Cobalt. 

How  is  each  form  jDrepared  and  aj^plied  ?   • 

Alls.  Arsenical  Paste. 

Arsenious  acid,  gr.  v,  basis. 

Morpli.  acetas,  gr.  x,  adjuvans. 

Creasotum  vel  acid,  carbolic,  gtt.  x,  constituens. 
3Iisce.  Apply  with  a  probe,  or  on  a  pellet  of  cotton. 

Devitalizing  Fibre, — Absorbent  cotton  is  reduced 
by  cutting  and  cross-cutting  to  a  fine,  soft  fuzz ; 
this  is  then  incorporated  with  a  mixture  composed 
of  arsenious  acid,  tannin,  carbolic  acid  and  opium, 
or  acetate  of  morphia.  It  is  then  dried,  and  sepa- 
rated in  small  pieces  for  convenient  application. 

Cobalt  is  powdered  and  made  into  a  paste  with 
any  medicament  desired.  As  it  owes  its  efficacy 
to  arsenic  in  combination,  its  use,  care  in  applica- 
tion, etc.,  would  be  the  same  as  arsenic. 


78  DENTAL  PATHOLOGY 

What  are  the  four  considerations  which  insure 
to  arsenical  applications  the  best  results  ? 

Ans.  Dryness,  accurate  application  of  medica- 
ment, proper  quantity,  and  maintenance  in  posi- 
tion. 

What  is  the  danger  in  arsenical  applications, 
and  what  are  the  four  means  for  guarding  against 
it? 

Ans.  That  it  may  get  out  of  the  cavity  upon 
the  gum  and  mucous  membrane  of  the  mouth. 
Guard  with  napkin  or  rubber  dam,  properly  j)re- 
pare  the  cavity,  accurately  place  medicament, 
securely  close  the  orifice  of  insertion  with  Tem- 
porary Sto23j)ing. 

What  is  the  proof  that  pulp  devitalization  is 
not  due  entirely  to  the  action  of  arsenic  ? 

Ans.  The  pulp  putrefies  if  allowed  to  remain 
in  the  tooth.  It  has  been  conclusively  proven 
that  tissue  containing  arsenic,  though  in  minute 
quantity,  does  not  putresce,  even  with  the  con- 
ditions of  heat,  moisture,  and  air  most  favorable. 

What  result  in  connection  with  tooth-tissue 
sometimes  follows  an  application  of  arsenic? 

Ans.  Suffusion  of  blood  produced  by  the  intense 
determination  and  thorough  congestion ;  pinkish 
or  purple  discoloration  of  the  crown  and  neck  of 
the  tooth. 

How  would  you  treat  a  "  suffused"  tooth  ? 

Ans.  Canals    should   be    cleansed    and   tempo- 


AXD   TIIKUArECTICF;.  79 

rarily  stopj^ed  above  tlie  suffusion,  tlie  cavity 
thoroughly  washed,  and  the  tooth  left  open  to  the 
fluids  of  the  mouth.  In  a  few  hours  or  days  a 
comparatively  natural  color  is  usually  restored. 

What  governs  repeated  applications  of  arsenic 
in  teeth  of  the  upper  or  lower  jaw  ? 

Ans.  In  the  upper,  proper  applications  may 
be  repeated  with  comparative  safety,  as  regard  is 
had  to  the  escape  and  subsequent  effects  of  the 
medicament  upon  the  gum  and  contiguous  mucous 
membrane,  gravity  and  the  oral  fluids  tending 
to  prevent  any  local  action  should  leakage  occur. 
In  the  lower,  gravity  and  oral  fluids  are  alike 
favorable  to  leakao-e  and  local  action  of  the 
medicament. 

What  are  the  six  considerations  which  maintain 
systematic  antagonism  in  the  treatment  of  deciduous 
and  j^ermanent  teeth  ? 

1.  Deciduous  teeth  are  for  tern-   '    1.  Permanent  teeth  are  for  per- 

porary  use.  manent  use. 

2.  Deciduous  teeth  are  filled  for      2.  Permanent  teeth  are  filled  for 

temporary  purposes.  permanent  purposes. 

3.  Roots    are    absorbing    or    ab-      3.  Roots    are    not    fully   formed 

sorbed    when    the    crowns  when     such     attention     to 

need  attention.  crowns  is  required. 

4.  Irritation  of  pulps  interferes      4.  Irritation  of  pulps  interferes 

with  absorption  of  roots.  with  formation  of  roots. 

5.  Devitalized  pulps  prevent  true      5.  Devitalized  pulps  prevent  for- 

absorption  of  roots.  mation  of  root?. 

6.  Every  consideration  points  to       0.  Every  consideration  points  to 

the    early    loss    of    rootless  |  the  usefulness  of  crownless 

crowns.  roots. 


80  DENTAL  PATHOLOGY 

EXTIEPATION    OF    THE    DENTAL    PULP. 

Upon  what  is  tlie  average  of  success  in  this 
operation  dependent  ? 

Ans.  Time  of  year,  physical  condition  of  j)^- 
tient,  temperament,  etc. 

What  is  the  point  for  "  tap"  in  each  tooth  ? 

Superior  centrals  on  lingual  face. 

"         laterals  on  ling-ual  face. 

"         cuspids  on  tuberosity  or  disto-labiallj". 

"         first  bicuspid  on  articulating  or  mesial  face. 

"         second  bicuspid  on  articulating  face. 

"         first  molar  on  articulating,  buccal,  or  mesial 
face. 

"         second   molar    on    articulating,    mesio-articu- 
lating,  or  bucco-articulating  face. 

"         third  molar  on  mesio-articulating  face. 
Inferior  centrals  and  laterals  on  lingual  face  just  pos- 
terior to  cutting  edge. 

"         cuspids  on  disto-labial,  near  edge  of  gum. 

"         first  bicuspid  on  mesio-buccal  face. 

"        second  bicuspid  on  mesio-buccal  face. 

"         first  molar  on  mesial,  buccal,  or  articulating 
face. 

"         second  molar  on  mesial,  buccal,  or  articulating 
face. 

"         third  molar  on  mesial,  buccal,  or  articulating  face. 

Which  teeth  give  better  promise  of  success, 
those  of  the  upper  jaw,  or  those  of  the  lower? 

Ans.  The  upper. 

Why? 

Ans.  Because  of  the  greater  vitality  and  lighter 
character  of  the  surrounding  osseous  structure ; 
gravity,  also,  exerts  a  beneficial  influence  upon  the 


AXD    THERAPEUTICS.  81 

effusions  of  congestion,  inflammation,  etc.,  thus 
assisting  in  the  prevention  of  external  scars,  etc., 
which  might  occur  from  abscess  and  the  like. 

What  is  the  first  indication  in  pulp  extir23ation  ? 

Ans.  Probe  gently  to  ascertain  as  to  sensation. 

AVhat  is  the  danger  to  broaches  in  extirpating  ? 

A71S.  Breaking  them  off  in  the  canal. 

What  is  the  objection  to  leaving  broken  broach 
or  probe  in  the  canal  ? 

Ans.  Presents  mechanical  difficulties  to  future 
venting  of  the  tooth. 

Give  treatment  of  canal  in  single-rooted  teeth. 

Ans.  Gain  access,  open  wide,  clean  out  well  with 
glycerine  and  alcohol,  or  oil  of  cloves.  Work  out 
filaments  of  pulp  with  probes ;  any  remaining  por- 
tions should  be  removed  by  syringing  with  tepid 
water  and  phenol-sodique.  As  each  canal  is  thus 
l^repared  as  thoroughly  as  possible,  dry  and  fill  with 
oil  of  cloves  or  glycerine.  This  is  done  by  working 
medicaments  into  canal  by  means  of  a  fine  j^robe ; 
any  surplus  should  afterwards  be  removed  with 
bibulous  jmper,  and  a  dressing  of  cotton  gently  in- 
serted, being  careful  not  to  fill  the  canal  flush  with 
the  jiul^^-chamber. 

Give  treatment  of  canals  in  multirooted  teeth. 

Ans.  Beginning  with  the  largest,  open,  clean, 
and  dress  in  turn,  same  as  single  roots.  As  the 
cotton  is  not  flush  with  the  pulp-chamber,  it  is  not 
disturbed  in  drilling  and  cleaning  other  portions 


82  DENTAL   PATHOLOGY 

of  the  cavity  and  other  canals.  The  finest  canals, 
which  do  not  permit  of  cotton  dressing,  being 
sinij)ly  filled  with  the  medicament  used.  The 
pulp-chamber  and  entrance  is  then  temporarily 
stopped,  usually  for  a  week. 

Why  is  the  largest  canal  treated  first? 

Ans.  Because  the  bulk  of  devitalized  tissue  is 
thus  removed,  re-entrance  of  debris  prevented  into 
canals  that  have  been  cleaned,  and  the  final  and 
proper  treatment  (working  in  medicaments  by 
means  of  probes)  of  the  smallest  canals  just  before 
temporarily  closing  the  tooth  allowed. 

What  time  should  usually  be  given  after  extir- 
j)ation  ? 

Ans.  If  the  parts  about  the  apex  of  the  root  ex- 
hibit but  slight  deviation  from  normality,  and  tem- 
peramental attributes,  physical  condition,  etc.,  are 
good,  then  a  short  space  of  time  will  generally  be 
required.  If,  however,  the  j)arts  become  tender, 
and  irritation  increases  (esj^ecially  in  low-grade 
temperaments),  then  the  proper  supporting  anti- 
phlogistic treatment  must  be  followed,  and  time 
allowed  for  the  re-establishment  of  a  comparatively 
normal  condition. 

What  is  taught  in  regard  to  hemorrhage  govern- 
ing this  ? 

Ans,  It  is  not  to  be  regarded  as  a  positively 
favorable  or  unfavorable  indication,  excejot  under 
normal  conditions.    Sometimes  no  bleeding  is  pres- 


AXD    THERAPEUTICS.  83 

ent,  and  yet  there  may  be  constant  oozing  of  effu- 
sions tlirougli  apical  foramen.  Such  teeth  require 
time  and  accurate  stopping  and  unstojjping  before 
a  permanent  filling  can  be  introduced.  The  safest 
method  to  follow  is  that  which  permits  of  the 
sloughing  and  separation  of  canal-tissue  from  out- 
side tissue ;  the  parts  heal  naturally,  and  no  hemor- 
rhage or  irritation  is  j^i'oduced  by  withdrawal  of 
the  pulp.  Temperament,  physical  condition,  etc., 
are  to  be  considered  in  this  connection. 

AVhat  is  meant  by  "  pulsating"  pulp  ? 

Ans.  One  which  throbs  or  pulsates  in  unison 
with  the  arteries. 

To  what  is  this  probably  due  ? 

Ans.  Enlarged  apical  foramen. 

What  is  the  jDrognosis  ? 

Ans.  Not  favorable. 

What  signs  distinguish  it  from  pulp  dying  ? 

Ans.  Decided  pain,  long-continued  paroxysms 
of  severe  suffering,  throbbing  pain,  and  imperative 
demand  for  relief. 

DENTAL    EXOSTOSIS. 

What  is  the  cause  of  this  disease  ? 
Ans.  Slight    and    continued    peridental   irrita- 
tion. 

What  time  is  required  for  its  development  ? 
Ans.  Months,  usually  years. 
What  is  its  ai^jiearance  ? 


84  DENTAL  PATHOLOGY 

Ans.  Chalky,  at  times  harder  and  yellowish- 
white  :  again,  polished  and  hard. 

What  is  its  form  ? 

Ans.  1st,  nodular ;  2d,  circumscribed  or  apical ; 
3d,  extended  or  diffused. 

At  what  age  does  it  occur  ? 

Ans.  Usually  found  only  in  adult  and  aged  teeth. 

AVhat  is  the  relative  liability  of  teeth  to  exostosis? 

Ans.  Incisors  and  cuspids  number  twenty-five 
per  cent. ;  bicuspids  and  molars,  seventy-five  per 
cent. 

What  connection  has  dental  caries  with  this 
disease  ? 

Ans.  It  is  one  of  the  most  infrequent  causes, 
and  is  dependent  upon  three  considerations : 

First.  Position. — This  must  be  under  the  free 
edge  of  the  gum,  and  encroaching  upon  the  ce- 
mentum. 

Second.  Extent. — It  is  not  necessary  that  such 
cavities  shall  be  very  large,  but  if  not,  then  they 
must  encroach  more  upon  cemental  than  dentinal 
structure. 

Third.  Character  of  Decay. — The  slow  variety 
is  more  likely  to  produce  exostosis  than  the  more 
rapid  forms. 

What  is  the  division  of  causes  of  exostosis  ? 

Ans.  First.  Mechanical. — Any  mechanical  irri- 
tation which  is  strong  and  frequent,  or  weak  and 
persistent,  is  liable  to  cause  it,  such  as  knocking 


AXD   THERAPEUTICS.  85 

the  teeth  together,  breaking  or  cracking  hard 
things,  biting  off  threads,  strings,  etc.,  protrusion 
of  fillings  so  as  to  impinge  upon  and  irritate  the 
peridentium,  slow  deposition  of  tartar,  mal-occlu- 
sion,  etc. 

Second.  Vital. — Large  metallic  i)lugs,  especially 
large  root  fillings,  dental  caries,  alveolar  abscess, 
necrosed  roots,  and  exostosed  teeth. 

What  is  its  usual  treatment  ? 

Ans.  Careful  extraction. 

What  might  be  its  treatment  ? 

Ans.  Extraction,  removal  of  exostosis,  and  re- 
plantation,— very  questionable  practice. 

What  are  the  symptoms  of  exostosis  ? 

Ans.  Dull,  gnawing,  uneasy  sensations,  usually 
located  in  or  about  the  tooth  or  root  affected;  not 
necessarily  persistent ;  never  very  acute ;  some  re- 
sjDonse  to  jDressure  and  tapping,  but  not  decided. 

FUSED    TEETH. 

What  is  the  peculiarity  of  these  ? 

Ans.  These  have  an  individual  and  separate  pulp 
for  each  tooth. 

AVhat  are  the  ordinary  causes  of  irritation  which 
produce  such  a  condition? 

Ans.  Exostosed  teeth  may,  by  extension  of  irri- 
tation, induce  it;  malposition  of  a  neighboring 
tooth  from  abnormal  direction  of  orowtli  sometimes 
produces  sufficient  irritation  to  fuse  its  roots  with 


S6  DENTAL  PATHOLOGY 

those  of  other  teeth.     Generally  it  may  be  stated 
that  irritation  of  root-tissue  causes  fused  teeth. 

ATTACHED    TEETH. 

What  is  the  peculiarity  of  these  ? 

A71S.  They  have  separate  ]}ulps,  and  their  roots 
are  mechanically  attached  to  each  other  by  the 
intervening  walls  of  their  alveoli.  Bone  and 
cementum  do  not  unite. 

GEMINOUS    TEETH. 

What  is  the  peculiarity  of  these  teeth  ? 

Ans.  Practically  they  have  but  one  pulp. 

What  causes  these  teeth  ? 

An%.  Abnormality  of  pulp-tissue. 

AVhat  operation  is  condemned  in  connection  with 
these  teeth  ? 

Ans.  Se2)aration. 

To  what  teeth  do  geminous  pulps  mostly  jDcrtain  ? 

Ans.  Mostly  to  centrals  and  laterals ;  sometimes 
to  laterals  and  cuspids  ;  rarely  to  molars. 

PERIODONTITIS. 

What  is  the  meaning  of  this  term  ? 
Ans.  Inflammation  of  the  peridentium. 
What  is  the  location  of  this  disease  ? 
Ans.  The  peridental  membrane. 
What  are  the  three  causes  of  general  periodon- 
titis ? 


AND   THERAPEUTICS.  87 

Ans.  Fuiictioiuil  derangement,  ^-ysteniic  debility, 
and  systemic  liyper-acidity. 

What  is  the  treatment  advised  for  the  first  two  ? 

Ans.  Consign  them  to  general  practice. 

What  for  the  third  ? 

Ans.  Small  doses  of  alkali,  such  as  bicarbonate 
of  soda. 

What  are  the  five  grades  of  periodontitis  ? 

Ans.  First  Grade. — Marked  soreness  of  tooth, 
circumscribed  as  to  tissue  irritation,  prompt  in 
aj^i^earance  of  symj^toms,  prompt  in  resolution  or 
permanent  cure  if  cause  is  removed,  and  requires 
no  su2'>port  when  drilling  vent. 

Second  Grade. —  Possesses  more  marked  soreness 
of  tooth,  not  so  prompt  in  aj^pearance  of  symptoms, 
more  extensive  as  to  tissue  irritation  (occurs  in 
high-grade  patients),  more  deliberate  resolution 
as  to  the  result  of  accurate  and  persistent  medica- 
tion. This  grade  requires  some  support  when 
drilling  vent. 

Third  Grade. — In  Nervo-bilious,  or  Nervo-san- 
guine  patients  develops  with  sufficient  celerity, 
soreness  all  over  the  parts,  pronounced  throbbing 
on  pressure  of  tooth,  general  febrile  excitement, 
cheeks  red  and  flushed,  systemic  sympathy,  etc. ; 
requires  utmost  gentleness,  and  accurate,  persistent 
medication,  together  with  pronij^tness  in  affording 
some  relief. 

Fourth  Grade. — Necessitates  an  almost  immedi- 


88  DENTAL  PATHOLOGY 

ate  and  frequently  an  immediate  abandonment  of 
antiplilogistic  medication,  and  proper  stimulation 
to  induce  suppuration.  This  grade  can  be  recog- 
nized by  the  non-success  of  the  ordinary  antiphlo- 
gistic treatment,  venting  of  tooth,  etc. 

Fifth  Grade. — Occurs  in  Bilio-nervous  and 
Bilio-lymphatic  temperaments.  Very  little  com- 
fort or  success  can  be  hoped  for  in  this  grade. 
The  teeth  on  either  side  of  the  affected  one  are 
exquisitely  tender  and  responsive ;  tissue  irritation 
is  extensive ;  medication  does  no  good ;  cannot  run 
on  to  suppuration ;  only  a  high  grade,  active  in- 
flammation ;  great  systemic  sympathy.  Extraction 
is  the  only  remedy,  and  then  persistent  and  ac- 
curate treatment  is  required  to  prevent  the  loss 
of  adjoining  teeth  in  the  same  manner. 

What  are  the  seventeen  recognized  causes  of 
periodontitis  ? 

1st.  Want  of  occlusion. 

2d.  Mal-occlusion. 

3d.  Salivary  calculus  and  tartar. 

4tli.  Looseness  of  tooth  or  root. 

oth.  Induration  of  tooth-tissue. 

6th.  Cavity  of  decay  impinging  on  the  cementuni. 

7th.  Mechanical  irritation. 

8th.  Dental  manipulation. 

9th.  Excess  of  filling  material. 
10th.  Inflammation  of  pulp. 

11th.  Excision  of  pulp  without  alleviating  hemorrhage. 
12th.  External  irritation  by  forcible  withdrawal  of  pulp. 
13th.  Putrescent  pulp. 
14th.  Previous  periodontitis. 


AND   THERAPEUTICS.  89 

15th.  Action  of  medicine  locally. 
16th.  Action  of  medicine  systemically. 
17th.  Action  of  virus. 

What  are  its  symptoms  ? 

Ans.  Knowledge  of  the  presence  of  the  tooth, 
desire  to  work  it  with  the  finger  or  press  it  with 
the  tongue ;  soreness ;  peculiar,  acute,  throbbing 
pain  beating  with  the  circulation  ;  violent  suffering 
from  striking  and  taj^ping  not  only  the  affected 
tooth,  but,  230ssibly,  adjoining  ones. 

What  is  its  sign  ? 

Ans.  Interference  with,  or  obliteration  of,  the 
health  line. 

What  is  the  health  line  ? 

Ans.  A  line  of  demarcation  between  the  pale- 
j)ink  and  deep-red  gum-tissue. 

What  is  the  decisive  test  for  peridental  irritation  ? 

Ans.  Tapping  upon  the  tooth  and  pressure. 

What  is  the  only  termination  of  periodontitis  ? 

Ans.  Resolution. 

What  form  of  dental  disease  is  established  by- 
any  other  termination  ? 

Ans.  Alveolo-dental  abscess. 

What  are  the  three  local  and  ttvo  general  con- 
siderations in  the  treatment  of  periodontitis  ? 

Ans.  Local. — 1st.  Removal  of  irritants,  vital  or 
mechanical.  2d.  Absolute  rest  of  the  parts.  3d. 
Application  of  tonics,  astringents,  or  stimulants, 
counter-irritants,  sedatives,  etc. 

7 


90  DENTAL  PATHOLOGY 

General. — 1st.  Diet,  rest,  exercise.  2d.  Some 
aperient,  as  Hunyadi  water,  Epsom  salts,  small 
dose  largely  diluted;  add  one-half  bottle  Citrate 
of  Magnesia ;  take  before  breakfast. 

Into  what  two  forms  is  periodontitis  divided  ? 

Ans.  1st.  Sthenic,  acute,  circumscribed,  or  phleg- 
monous. 2d.  Asthenic,  chronic,  diffused,  or  ery- 
sipelatous. 

What  complications  render  the  second  form  more 
difficult  of  treatment  ? 

Ans.  Temperamental  and  systemic  complica- 
tions. 

What  are  the  two  forms  of  general  treatment  in 
periodontitis  ? 

Ans.  Pro23hylactic  or  Preventive,  and  Curative. 

What  is  the  division  of  the  chronic  form  of 
periodontitis  ? 

Ans.  Benignant  and  Malignant. 

How  is  a  local  or  systemic  cause  of  periodontitis 
diagnosed  ? 

Ans.  If  a  local  cause,  the  inflammation  stops,  as 
a  rule,  at  the  mesial  line.  If  this  point  is  passed, 
the  inflammation  is  purely  systemic  or  complicated 
with  a  local  cause. 

What  are  the  systemic  causes  ? 

Ans.  1st.  Syphilitic  virus.  2d.  Mercurial  poi- 
soning.    3d.  Phosphorus. 


AND   THERAPEUTICS.  91 

ALVEOLAR   ABSCESS. 

Give  the  definition  of  alveolar  abscess. 

Ans.  A  cavity  containing  pus,  having  its  incipi- 
ency  in  the  cancellated  structure  between  the  alve- 
olar i^lates. 

What  are  the  six  causes  given  for  alveolar  ab- 
scess ? 

Ans. 

1st.  Putrescent  pulp. 
2cl.  Tartar. 

3d.  A  necrosed  tooth  or  root. 
4th.  Carious  bone. 
5th.  Necrosed  bone. 

6th.  Foreign  materials,  such  as  oyster-shell,  pieces  of 
bone,  coal,  etc.,  from  the  food  ;  splinters,  bristles 
from  tooth-brush,  portions  of  filling  material, 
protruding  canal  fillings,  broken  probe,  etc. 

In  what  condition  are  the  parts  placed  by  the 
removal  of  any  one  of  the  last  five  causes  ? 

Ans.  In  a  condition  which  permits  of  a  natural 
restoration  to  health. 

In  what  condition  is  a  tooth  left  by  removal  of 
the  other  cause  ? 

Ans.  In  such  condition  as,  by  proper  treatment 
("frequent  stopping  and  unstopping,"  etc.),  to  give 
reasonable  hopes  for  a  longer  or  shorter  period  of 
comfort  and  usefulness. 

Why  ? 

Ans.  Because  "  previous  disease"  constitutes  a 
"  predisposing  cause"  to  disease  in  the  future ;  so 


92  DENTAL  PATHOLOGY 

that  when  an  "  exciting  cause"  is  again  applied, 
the  parts,  being  in  only  a  com'parat'wely  normal 
condition,  are  easily  disordered  and  irritated. 

What  is  the  difference  in  treatment  of  abscess 
from  putrescent  pulp  with  fistulous  opening  and 
without  ? 

Ans.  With  a  Fistulous  Opening. — First  effect  an 
entrance  to  pulp-cavity ;  open  widely  and  gain  free 
access;  remove  all  putrescent  material  by  means 
of  probes,  syringing,  and  antiseptic  medicaments, 
being  careful  not  to  force  medicaments  through 
fistulous  opening.  Use  easy,  soothing  canal  dress- 
ing, such  as  Iodoform  Paste,  Morphia  and  Oil  of 
Cloves,  Tincture  of  Calendula,  Oil  of  Cajeput,  etc. ; 
by  which  treatment  the  natural  healing  of  the 
abscess  and  fistula  in  a  short  space  of  time  is  per- 
mitted. After  such  treatment  the  tooth  may  be 
filled  at  once,  if  desired. 

Without  Fistulous  Opening. — Having  no  exit 
except  by  way  of  the  apical  foramen  out  through 
the  tooth.  Such  teeth,  feeling  long,  sore,  and 
tender  to  the  touch,  require  counter-pressure  when 
drilling  relief-hole  for  the  excavation  of  pus.  The 
gum  should  be  gently  pressed  until  not  only  all 
pus  is  evacuated,  but  some  blood  appears ;  a  little 
pus  will  afterwards  form  (from  some  degenerated 
tissue  necessarily  left  about  the  apex  of  the  roots) 
even  in  the  best  temperaments,  and  more  will  form 
in  low-grade  temperaments.     A  first  consideration, 


s 


AXl)    TJI/:i!APEUTICS.  !l3 

then,  is  whether  the  abscess  will  l)e  sufficiently 
relieved  by  the  vent-hole  for  a  natural  cure,  or 
Avhether  a  fistulous  opening  will  have  to  be  estab- 
lished. This  may  be  determined  by  leaving  the 
tooth  open  for  two  or  three  days,  when,  if  relief  is 
not  sufficient,  it  will  be  announced  by  return  of 
pain,  swelling,  etc",  (esj^ecially  if  relief-hole  is 
stojiped  up) ;  a  choice  is  then  had  of  three  things : 
1st,  liastening  on  to  suppuration  and  formation  of 
fistula  by  closing  vent-hole  and  applying  a  pepper 
bag ;  2d,  iancing  through  the  tissue  ;  3d,  drilling 
an  opening  through  alveolus  to  apex  of  root,  thus 
making  an  artificial  fistula.  To  do  this  with  com- 
2:>arative  comfort  to  patient,  give  gentle  inhalations 
of  chloroform  one  part,  and  alcohol  two  or  three 
parts,  until  the  glow  and  buzzing  is  felt  by  the 
patient.     For  drilling  use  a  strong,  tough  drill. 

What  are  the  various  medicaments  recommended 
for  use  inside  of  teeth  which  have  abscessed  from 
putrescent  pulp  ? 

Alls.  They  may  be  included  under  the  heads  of 
"  soothing  or  antiphlogistic,"  "  stimulating,"  and 
"  antiseptic"  medicaments.  Acetate  of  Morphia 
Paste,  Glycerine,  Alcohol,  Tincture  of  Calendula, 
Oil  of  Cajeput,  Eucalyptus,  Cloves,  Iodoform,  etc. 

What  medicaments  are  recommended  to  be  ap- 
plied upon  the  gums  in  cases  without  fistulse  ? 

Ans.  Oil  of  Cloves,  Dent.  Aconite,  Tincture  of 
Arnica,  Lead-Water  and  Laudanum,  Dent.  Tine- 


94  DENTAL  PATHOLOGY 

ture  of  Iodine,  Capsicum,  Ginger,  Chloroform, 
Hamamelis,  Plienol-Sodique,  Tincture  of  Calen- 
dula, etc. 

What  medicaments  are  recommended  for  intro- 
duction to  fistula  by  syringing  ? 

Ans.  Tincture  of  Calendula,  Tincture  of  Arnica, 
Tincture  of  Capsicum,  Phenol-Sodique,  Laudanum, 
Hamamelis,  Chloral  Hydrate,  Chloride  of  Zinc, 
Sulphuric  Acid,  Carbolic  Acid,  Iodoform,  Chlorate 
of  Potassa,  Oil  of  Cloves,  Glycerine,  etc. 

Which  are  used  in  full  strength,  and  which  di- 
luted ? 

FULL    STRENGTH. 

Phenol-Sodique.  Tincture  of  Capsicum. 

Oil  of  Cloves.  Hamamelis. 

Glycerine.  Laudanum. 

Tincture  of  Calendula. 

DILUTED. 

Carbolic  Acid.  Tincture  of  Capsicum. 

Tincture  of  Calendula.  Tincture  of  Arnica. 

Phenol-Sodique.  Sulphuric  Acid. 

Iodoform.  Chloride  of  Zinc. 

Chloral  Hydrate.  Chlorate  of  Potassa. 

What  is  the  strength  of  each  dilution  ? 

Ans. 


Carbolic  Acid       .     .     . 

1 

part  to 

25  or  50  of 

water 

Tincture  of  Capsicum  . 

1  part  to  10, 

15,  or  30 

Tincture  of  Calendula  . 

part  to  10  or  20 

Tincture  of  Arnica  .     . 

a 

5  or  15 

Phenol-Sodique    .     .     . 

a 

10  or  20 

Sulphuric  Acid    .     .     . 

u 

3  or    6 

Chloride  of  Zinc .     .     . 

u 

5  or  15 

Glycerine 

u 

8  or    5 

Chloral  Hydrate  .     .     . 

u 

5  or  10 

AND    rilERAPEUTICS.  95 

What  are  the  i">ossibilities  and  probabilities  of, 
recurrence  of  abscess? 

Ans.  The  possibilities  are  that  it  may  recur  at 
any  time ;  the  probabilities  are  that  it  ivill  not 
recur  within  a  reasonable  period. 

Upon  what  do  these  de23end  ? 

Ans.  Age,  sex,  temperament,  occupation,  mode 
of  life,  2^hysical  condition,  systemic  drain,  etc. 


APPENDIX. 


MISCELLANY. 

What  are  the  essentials  to  be  recognized  in 
connection  with  pulp  extirpation  ? 

Ans.  Free  openings,  easy  access  to  jDulp-cavities 
and  canals,  soothing  and  cleansing  medication, 
thorough,  gentle  manipulation,  and  the  recognition 
that  more  or  less  time  is  required  for  the  restora- 
tion of  comparative  normality  about  the  aj^ex  of 
the  root. 

Is  it  ahvays  possible  to  clean  and  fill  to  the 
very  aj^ex  of  all  roots  ? 

A71S.  It  is  not.  Many  roots,  from  their  small 
size,  peculiar  shape,  position,  etc.,  are  accessible 
for  only  a  limited  portion  of  their  extent. 

AVhat  are  the  six  considerations  in  connection 
with  pulp  irritation  from  disease  of  the  surround- 
ing parts  ? 

Ans.  Salivary  calculus,  tartar,  looseness  of  tooth, 

abscess  and  atrophy  or  absorption  of  either  gum, 

alveolar  process,  or  roots. 

If  deciduous  first  molars  are  extracted  between 

97 


98  DENTAL   PATHOLOGY 

the  ages  of  five  and  seven  years,  what  injury  may 
be  inflicted  ? 

Ans.  Mechanical  injury  to  the  developing  bi- 
cuspids ;  for  at  this  time  the  roots  of  the  deciduous 
molar  are  but  slightly  absorbed,  and  clasp  the 
alveolar  structure  which  encircles  the  nearly  de- 
veloped crown  of  the  bicuspid. 

In  what  rare  cases  of  irritation  does  the  "health 
line"  remain  unchanged? 

Ans.  Pulsating  pulps,  nodular  calcification,  api- 
cal or  circumscribed  exostosis,  and  circumscribed 
necrosis. 

How  is  pulp-irritation  from  loss  of  tooth-sub- 
stance distinguished  from  sensitive  dentine  ? 

Ans.  If  pulp  is  irritated,  the  most  tender  spot  is 
directly  over  the  portion  or  portions  of  jDulp  most 
nearly  exposed ;  if  sensitive  dentine,  it  is  usually 
more  on  one  edge  than  in  the  central  part  of  the 
abrasion. 

What  is  the  diflerence  in  the  character  of  the 
pain  arising  from  irritation  of  the  pulp  from  loss 
of  tooth -substance  by  attrition  and  that  from  sen- 
sitive dentine? 

Ans.  The  pain  from  sensitive  dentine  is  not  pos- 
itively located  unless  touched,  but  gives  a  general 
sense  of  uneasiness  through  the  teeth,  jaws,  cheeks, 
eye,  and  adjacent  parts ;  these  symptoms  appear 
gradually  and  continue  for  long  periods  of  time, 
exhibiting  no  paroxysms  of  severe  suffering.     The 


ASD    IIIERAPEUTICS.  <(9 

puiii  Iroiii  irrilatcd pulp  is  geiienilly  more  decidedly 
localized  even  to  the  affected  tooth ;  it  appears 
quite  suddenly,  increasing  in  intensity  day  by  day, 
developing  paroxysms  of  increasing  severity.  Hot 
and  cold  api)lications  cause  much  pain ;  cooling 
liquids  relieve  the  irritation  induced  by  hot  drinks, 
such  as  soup,  coffee,  tea,  chocolate,  etc.,  while  tepid 
water  affords  equal  relief  when  the  irritation  has  re- 
sulted from  the  contact  of  ice-cream,  ice-w^ater,  etc. 

What  in  this  connection  is  an  important  diag- 
nostic between  sensitive  dentine  and  an  almost  ex- 
posed pulp  ? 

Ans.  The  possible  cessation  of  response  on  the 
part  of  sensitive  dentine  after  only  one  touch,  and 
the  probable  continuation  of  response  on  the  part  of 
an  almost  exposed  j^ulp  after  any  number  of  touches. 

What  is  usually  the  best  method  of  remedying 
irritation  of  the  pulp  from  the  loss  of  tooth-sub- 
stance ? 

Ans.  The  cutting  away  of  the  tooth,  wdiicli  an- 
tagonizes and  abrades  the  one  giving  pain,  together 
with  the  judicious  selection  of  three  or  four  not 
unduly  'worn,  articulating  teeth  for  the  purpose  of 
making  shallow  cavities  and  introducing  ordinary 
crown  or  surface  fillings,  that  further  abrasion  may 
be  precluded,  or,  at  least,  retarded. 

What  condition  is  sometimes  found  analogous  to 
a  loss  of  tooth  structure  by  attrition,  and  eventu- 
ating in  the  same  symptoms  ? 


100  DENTAL  PATHOLOGY 

Ans.  Sometimes  a  marked  clean  cwp'ping  occurs 
on  tlie  cutting  edges,  cusps,  and  articulating  faces 
of  teeth. 

To  what  is  this  due  ? 

Ans.  It  is  not  due  entirely  to  mastication,  but 
may  be  regarded  as  one  peculiar  phase  of  dental 
caries;  the  exjDosed  dentine  being  different  in  ap- 
j)earance  from  the  polished  and  hardened  surface 
usually  resulting  from  the  wear  of  mastication. 
The  dentine  (in  this  cupping  caries)  seems  to  be 
softened,  and  therefore  yields  more  readily  than 
the  enamel  to  the  disintegrating  influence  of  mas- 
tication ;  in  consequence  of  this  the  interior  and 
edges  of  such  cavities  present  a  smooth,  defined, 
and  clean  appearance. 

How  is  this  condition  treated  ? 

An§.  In  the  same  manner  as  loss  of  tooth-sub- 
stance by  attrition. 

Upon  what  is  fracture  of  the  teeth  dependent  ? 

Ans.  Upon  one  of  four  causes. 

Name  them. 

An8.  1st.  Impinging  upon  some  hard  substance 
during  mastication,  such  as  bone,  coal,  shot,  nut- 
shells, oyster-shells,  metal  fillings  loosened  and 
detached  by  pressure  of  food,  etc.,  or,  2d,  where 
decay  has  largely  j^rogressed,  leaving  thin  walls  of 
enamel  which  are  easily  broken  by  the  pressure  of 
ordinary  food,  such  as  pop-corn,  candy,  bread-crust, 
or  even  soft  bread ;  3d,  fracture  from  blows  or  falls. 


Ai\'D    THERAPEUTICS.  101 

or,  4th  (very  unusual),  fracture  from  congestion  of 
the  pulp.  When  this  occurs  there  is  usually  a 
sense  of  fulness  in  the  tooth,  rapidly  passing  into 
extreme  tension  or  pain,  or  into  tense  numbness 
and  growing  uneasiness. 

Give  some  important  points  in  relation  to  the 
re-establishment  of  normality  in  diseased  tissue. 

Ans.  First.  In  proportion  to  the  extent  and  se- 
verity of  disease  in  connection  with  any  tissue  is 
the  re-establishment  of  normality  rendered  impos- 
sible. 

Second.  Slight  irritation  usually  permits  of  a 
return  to  comparative  normality,  but  a  decided 
irritation  renders  such  return  less  probable. 

Third.  Slight  inflammation  sometimes  permits 
of  the  re-establishment  of  apparent  normality,  but 
it  much  more  frequently  gives  decided  evidence  of 
what  is  termed  "  weakness"  of  the  part  by  reason 
of  irritation,  if  not  of  recurrence  of  positive,  though 
slight,  inflammation. 

Fourth.  Severe  inflammation  may  be  regarded, 
practically,  as  a  deviation  so  great  as  to  preclude 
the  possibility  of  a  return  to  absolute  health  on 
the  part  of  any  organ  or  tissue  so  affected. 

What  is  meant  by  "  thoroughness"  as  understood 
from  the  "  New  Departure"  stand-point  ? 

Thoroughness  means  tootJt  saving,  not  "tooth 
filling'^;  exemption  from  pain,  not  "infliction";  gen- 
tle yet  thorough  impact,  not  "  forcible  conformity"  ; 


102  DENTAL  PATHOLOGY 

harmony,  not  golden  jarring;  resistance  propor- 
tioned to  demand ;  "  perfect  adaptation"  to  the 
requirements  of  the  case,  whether  "tightness"  or 
looseness  ;  comfortable  service  rather  than  "  elegance 
of  finish." 

Under  what  circumstances  is  "  external  irritation 
by  forcible  withdrawal  of  pulp"  easily  possible  ? 

Ans.  During  removal  of  recently  devitalized 
pulps,  particularly  from  teeth  of  Sanguo-lymphatic, 
Nervo-lymphatic,  or  Bilio-lymphatic  patients. 

Is  it  proper  to  place  medicaments  in  teeth  (which 
have  had  peridental  irritation  from  putrescent 
pulps)  immediately  after  giving  relief  by  drilling 
into  pulp  cavities  ?     Why  ? 

Ans.  It  is  not ;  as  increased  irritation,  either  by 
permeation  of  already  irritated  tissues,  or  by  me- 
chanically obstructing  the  only  avenue  for  the  pas- 
sage of  existing  effusions  (by  inspissation  of  con- 
tents of  pulp  cavities  and  canals),  would  follow. 
Especially  should  medication  on  cotton  pellets  or 
tivists  be  avoided. 

What  is  the  one  symptom  which  indicates  very 
reliably  the  complex  pathological  condition  of  peri- 
odontitis from  inflammation  of  a  pulp  f 

Ans.  The  peculiar  duplex  character  of  the  pain, 
by  which  is  added  to  the  tenderness  uj^on  j^ressure 
the  throbbing  and  the  sense  of  tooth  elongation,  a 
decided  alternate  exacerbation  and  amelioration  of 
suffering. 


AXD    THEnAPEUTICS.  103 

Is  paroxysmal  suffering  or  exacerbation  con- 
nected with  true  periondoutitis  ? 

Ans.  Usually  it  is  not ;  but  when  such  combina- 
tion is  present  a  pulp  is  dying  from  peridental 
irritation,  especially  when  between  paroxysms  a 
response  to  hot  or  cold  fluids  is  had.  (This  holds 
good  so  far  as  single-rooted  teeth  are  concerned.) 

Upon  what  do  acute  and  chi'onic  forms  of  peri- 
odontitis depend  ? 

Ans.  Upon  temperament  and  j^hysical  condition. 
All  high-grade  temperaments  (from  first  to  third 
grade)  are  liable  to  the  acute  form,  provided  the 
system  is  not  depressed.  Low-grade  tempera- 
ments (such  as  Bilio-lymphatic)  have  the  chronic 
form. 

AVhat  is  the  difference  between  the  two  forms  ? 

Ans.  Time  of  duration.  If  lasting  from  one  to 
three  or  five  days,  it  is  acute ;  after  this  it  is  called 
chronic 

What  is  the  line  of  distinction  between  perio- 
dontitis and  alveolar  abscess  ? 

Ans.  As  soon  as  the  smallest  portion  of  pus 
forms,  periodontitis  ends  and  abscess  begins. 

What  medicaments  are  recommended  for  con- 
trolling hemorrhage  ? 

Ans.  Tincture  of  Erigeron  Canadense  is  used 
where  patient  is  of  bilious  type,  dark  hair,  dark 
eyes,  etc.  For  those  with  light  hair,  fair  skin,  etc., 
use  Tincture  of  Chenopodium  Album.     Both  are 


104  DENTAL  PATHOLOGY 

styptics  and  hsemostatics.  Dose :  gtt.  iii  to  v,  once 
every  lialf-liour,  or  gtt.  i,  every  one  or  two  min- 
utes, until  effects  are  produced. 

When  is  Dental  Iodine  used  in  a  tooth  ? 

Ans.  In  treatment  of  fungous  gum  or  pulp,  and 
for  pain-obtunding  and  devitalizing  purposes  in 
children's  teeth. 

What  is  the  treatment  for  ijiduration  of  tooth- 
tissue  ? 

Ans.  Nothing  can  be  done.  Systemic  treat- 
ment is  the  only  hope. 

AVhat  are  the  cause  and  effects  of  induration  ? 

Ans.  Its  cause  is  probably  systemic,  and  its 
effects  are  intense  calcification  of  the  cementum, 
and  attempts  at  exfoliation  of  the  tooth. 

Under  what  three  heads  is  "  excess  of  filling 
material"  considered  ? 

Ans.  First.  On  the  articulating  surface,  bringing 
all  impact  on  one  tooth. 

Second.  On  any  face  of  a  tooth,  where  the  cavity 
imi^inges  on  the  cementum. 

Third.  Excess  through  apical  foramen. 

Which  form  of  excess  is  incurable  ? 

Ans.  Excess  through  apical  foramen,  especially 
when  canal  has  been  solidly  filled  with  foil,  oxy- 
chloride  and  cotton,  gutta-]3ercha,  etc. 

What  is  the  first  indication  for  periodontitis 
from  putrescent  pulp  ? 

Ans.  Give   relief  by   drilling  vent-hole,  or  in 


jyn   TUEltAPEUTICS.  105 

some  manner  permitting  the  mephitic  gas  to 
escape. 

What  are  three  considei'ations  under  this  head  ? 

Ans.  First.  How  to  drill  vent-hole  with  least 
infliction  to  patient. 

Second.  Where  an  opening  into  the  pulp-cham- 
ber  can  be  effected  with  the  least  injury  to  the  tooth, 
and  the  best  lookout  for  future  considerations. 

Third.  Gaining  a,  fair  access  to  canals  in  order 
-to  obtain  the  best  results. 

Where  are  "relief-holes"  usually  drilled? 

Ans.  From  the  incisors  to  the  second  bicusi^ids 
at  the  necks  disto-buccally. 

On  the  second  bicusj^ids  buccally. 

On  the  molars  mesio-buccally. 

How  long  has  the  drilling  of  vents  been  in 
practice  ? 

Ans.  About  forty  years. 

What  is  the  result  of  drilling  a  vent  ? 

Ans.  It  not  only  affords  an  avenue  for  the  es- 
cape of  mephitic  gas,  but  also  j^ermits  the  j)erice- 
mental  membrane  to  relieve  itself  of  exudations. 

What  is  meant  by  "  tiding  over"  a  pul])  ? 

Ans.  At  times,  in  persons  of  low-grade  tem- 
peramental attributes  (es23ecially  in  warm  weather), 
the  system  is  in  such  a  weakened  condition  as  not 
to  have  sufficient  strength  to  set  up  a  flow  of  blood 
powerful  enough  to  destroy  a  pulp  even  when 
arsenic  is  applied  for  the  purpose  of  devitalization. 


106  DENTAL  PATHOLOGY 

The  case  is  tlien  treated  in  such  manner  as  to  give 
the  greatest  amount  of  comfort  until  the  system  is 
in  pro23er  condition  to  respond  to  arsenic. 

What  are  signs  ?     What  are  symptoms  ? 

Ans.  Signs  are  what  doctors  should  observe. 
Symptoms  are  what  patients  feel,  and  should  de- 
scribe. 

AESENIC. 

What  time  is  required  for  arsenical  devitaliza- 
tion of  the  pulp  ? 

Ans.  There  is  no  relation  between  time  and 
ai^senical  action;  the  time  required  is  governed 
entirely  by  temperament  and  physical  condition. 

Why  is  it  improper  to  apply  arsenic  to  an  in- 
flamed pulp  ? 

Ans,  Because,  on  account  of  the  full  and  dis- 
tended blood-vessels,  and  retarded  circulation,  its 
dynamic  and  vital  impression  cannot  be  produced. 

What  is  the  effect  of  arsenic  when  applied  on 
the  surface  of  partially  devitalized  j^ulps  ? 

Ans.  No  effect  whatever. 

What  effect  is  produced  by  arsenic  when  applied 
to  a  dead  pulp  ? 

Ans.  No  effect. 

Does  the  presence  of  the  arsenical  application 
prevent  decomposition  of  the  pulp  ? 

Ans.  It  does  not. 

If  arsenic  is  sealed  in  the  pulp  cavity  of  a  per- 


AND   THERAPEUTICS.  107 

fectly  developed  tooth,  can  it  pass  through  dentine 
and  cementuni  ? 

Ans.  It  cannot. 

If  arsenic,  when  applied  to  a  tooth,  passes  through 
the  dentine  and  affects  the  pulj),  why  will  it  not 
pass  through  dentine  (when  sealed  in  pulp  cavity) 
and  affect  the  cemeutum  ? 

Ans.  Because  the  dentine,  being  dead,  offers  an 
effectual  barrier  to  its  passage. 

How  soon  after  application  of  arsenic  is  it  possi- 
ble for  alveolar  abscess  to  supervene  ? 

Ans.  It  depends  entirely  upon  temperament, 
physical  condition,  etc.  Generally  from  one  month 
to  a  year  or  two. 

OXYCHLORIDE    OF    ZINC. 

Does  Oxychloride  of  Zinc  possess  the  power  of 
mummifying  pulps  which  may  die  under  it  ? 

Ans.  It  possesses  no  such  j^ower. 

Is  Oxychloride  used  as  a  permanent  filling  ma- 
terial ? 

Ans.  It  is  not,  except  in  rare  cases. 

Why? 

Ans.  Because  it  fails  in  two  ways :  1st,  from 
attrition ;  2d,  from  solution  or  disintegration  at 
the  cervical  portion  of  the  filling. 

What  is  it  especially  used  for  ?  • 

Ans.  As  a  lining  to  cavities  having  thin,  frail 
walls. 


MEDICAMENTS. 


1st.  Alcohol, '='  95  per  cent,  (burning,  not  drug- 
gists').— Used  for  cleaning  canals  from  putrescent 
matter,  and  as  ^  first  loose  dressing  for  them.  Good 
also  to  cleanse  cavities  from  decaying  debris,  etc. ; 
also  used  as  a  dryeo'  preparatory  to  filling ;  is  a  sweet- 
ener and  deodorizer. 

2d.  Glycerine.'^' — Used  for  cleansing  canals ; 
follow  with  alcohol,  or  alcohol  first,  and  follow 
with  glycerine.  Generally  it  is  easier  to  manipu- 
late canals  of  upj^er  teeth  with  glycerine ;  alcohol 
being  so  thin  is  difficult  to  apply.  Glycerine  is  a 
powerful  antiseptic  and  solvent,  as  much  so  as  car- 
bolic acid  or  creasote.  For  mixing  with  other 
medicaments,  on  account  of  its  solvency,  for  den- 
tal ^lur^^oses  it  is  invaluable.  Can  be  used  to  "dry 
out"  dentine,  etc.     Is  antiseptic,  detergent,  etc. 

3d.  Oil  of  Cloves.'-' — A  stimulant,  deodorizer, 
sweetener,  pain-obtunder,  etc.    Is  used  as  a  dressing 

*  Students'  list  of  medicaments. 

109 


110  DENTAL  PATHOLOGY 

in  canals  after  cleansing,  for  sensitive  dentine,  pulp 
irritation,  etc.  Is  very  useful  in  separating  teeth, 
as  it  prevents  soreness  of  gum ;  good  also  for  "  pel- 
leting" ingrowing  gum.  Used  to  make  Acetate  of 
Morphia  Paste  and  Oil  of  Cloves  Ointment. 

Naboli,  Nos.  i  and  2. — Is  good  where  oil  of 
cloves  does  not  work  well ;  is  a  nice  pain-obtunder, 
and  does  not  burn  the  mouth ;  is  good  for  use  in 
children's  mouths,  where  they  object  to  oil  of 
cloves.     Naboli  draws  water  from  the  dentine. 

Oily  Carbolic  Acid. — Comes  in  best  shape 
marked  creasote.  "  Merck's"  is  the  best.  It  ranges 
from  a  mild  deodorizer  to  a  powerful  escharotic.  Is 
used  for  application  in  cavities  for  sensitiveness  in 
separating.  First  take  a  small  pellet  of  cotton 
touched  with  oil  of  cloves,  and  place  it  between  the 
teeth,  then  cover  with  a  drop  of  sandarac.  After 
two  or  three  preparations,  place  a  very  minute  por- 
tion of  carbolic  acid  in  cavity ;  it  will  obtund  sensi- 
tiveness, and  the  operator  may  wedge  then  harder. 
In  oily  carbolic  acid  we  come  to  the  first  of  medi- 
caments that  may  be  dangerous  to  pulps. 

Acetate  of  Morphia.* — Useful  in  aching  pulp, 
sensitive  dentine,  etc.  Is  also  an  excellent  medica- 
ment to  use  as  a  canal  dressing  (in  form  of  paste). 

*  Students'  list  of  medicaments. 


AND   TnERAPEUTICS.  Ill 

Cover  with  temporary  stopping,  and  allow  to  re- 
main in  canals  for  a  clay,  a  week,  or  more.  Is  one 
of  the  components  of  Arsenious  Acid  Paste. 

1.  R   Arsenious  Acid,  gr.  v  ; 

Acetate  of  Morphia,  gr.  x  ; 

Oily  Carbolic  Acid,  sufficient  quantity, 

2.  R    Arsenious  Acid,  gr.  v; 

Tannic  Acid,  gr.  ij  ; 
Acetate  of  Morphia,  gr.  x  ; 
Moisten  pellet  and  dip  it  into  the  powder. 

3.  R  Arsenious  Acid.  gr.  v  ; 

Acetate  of  Morphia,  gr.  x  ; 

Oil  of  Cloves,  sufficient  quantity. 

4.  R   Arsenious  Acid,  gr.  v  ; 

Acetate  of  Morphia,  gr.  x  ; 

Dental  Tincture  of  Aconite,  sufficient  quantity. 

Devitalizing  Fibre. 

R  Absorbent  Cotton  (cross-cut  fine) ; 
Arsenious  Acid,  gr.  v  ; 
Tannic  Acid,  gr.  ij  ; 
Acetate  of  Morphia,  gr.  x; 
Oily  Carbolic  Acid,  q.  s.,  for  thin  paste. 

Dip  the  cut  cotton  in  the  mixture,  and  lay  it 
away  to  dry ;  it  can  be  used  where  the  ordinary 
arsenical  paste  cannot. 

Naboli,  No.  3.'^' — Often  causes  considerable  pain 
when  applied  to  a  tooth,  yet  it  is  a  notable  pain- 

*  Students'  list  of  medicaments. 


112  DENTAL  PATHOLOGY 

obtunder.  It  acts  as  a  dryer  to  dentine ;  takes  up 
the  water  more  violently  than  the  Nos.  1  and  2 ;  is 
the  intermediate  between  Oily  Carbolic  Acid  and 
Carbonate  of  Potassium,  or  Chloride  of  Calcium. 
(According  to  Letters  Patent,  No.  232,807.) 

R   Glycerine,  fl5i ; 

Tannic  Acid,  ^ii ; 

Chloral,  gr.  iv. 
Mix  thoroughly. 

Carbonate  of  Potassium."^' — (To  be  made  in  a 
clean  mortar.) 

5c   Glycerine,  31 ; 

Carb.  Potassium,  gr.  xv. 

Rub  up  Carbonate  of  Potassium  first ;  then  pour 
in  the  glycerine  and  rub  again,  then  set  away  for 
two  or  three  days,  when  all  the  carbonate  will  be 
dissolved  and  a  limpid  fluid  remain.  This  prep- 
aration is  excellent  for  sensitive  dentine ;  can  put 
it  under  the  gums,  around  necks  of  teeth,  etc. ;  is 
not  disagreeable  like  chloride  of  zinc.  [Before 
using  these  more  powerful  medicaments  for  sensi- 
tiveness, it  is  proper,  if  the  cavity  extends  near  to 
the  pulp,  to  place  in  a  guard  of  temporary  stopping 
to  preclude  the  possibility  of  any  irritation  to  the 
pul]).] 

Chloride  of  Zinc. — Sometimes  this  medicament 
gives  great  pain,  but  it  is  in  most  cases  bearable. 

*  Students'  list  of  medicaments. 


AXD   THERAPEUTICS.  113 

Deliquesce  and  pour  it  into  a  l)ottle ;  it  makes  one 
of  the  strongest  kind  of  j^iiin-obtunders.  If  pos- 
sible, it  is  always  best  to  use  other  and  milder 
obtunding  applications,  yet  it  is  very  useful  in  its 
place  and  when  needed.  Where  we  have  devitalized 
almost  to  the  end  of  canals,  on  account  of  the  failure 
of  Acetate  of  Morphia  Paste,  Dental  Tincture  of 
Aconite,  etc.,  to  completely  destroy  the  canals  are 
filled  with  Chloride  of  Zinc,  and  in  a  short  time 
the  work  is  finished.  Where  large  deposits  of 
tartar  have  to  be  removed,  chloride  is  used  for 
sensitiveness. 

Chloride  of  Zinc  is  a  polychrest;  a  very  few 
drops  in  a  glass  of  water  is  a  sweetener,  etc.,  as  a 
mouth  wash  ;  undiluted,  it  can  be  a  powerful  escha- 
rotic. 

Arsenious  Acid  Paste  and  Devitalizing 
Fibre  for  Devitalizing  Pulps. =•= 

R  See  under  head  of  Acetate  of  Morphia. 

Dental  Tincture  of  Aconite.'-' — One  of  the 
best  dental  antiphlogistics  and  pain-obtunders.  If 
a  gum  gives  trouble  from  extraction  of  a  tooth, 
use  aconite ;  if  a  i^ulp  gives  trouble,  use  aconite. 
If  periosteal  trouble  is  just  commencing,  use  Dental 
Tincture  of  Aconite,  dry  the  gum,  and  paint  the 
parts  with  aconite.  In  canals,  when  devitalizing, 
if  j^ainful,  use  aconite,  etc.,  etc. 

*  students'  list  of  medicaments. 


114  DENTAL  PATHOLOGY 

Dental  Tincture  of  Aconite.* 

R   Tincture  of  Aconite  Koot,  _^i. 

Place  in  a  broad-mouthed  bottle,  then  mark  it 
one-quarter  way  up,  and  let  the  tincture  evaporate 
to  the  mark.     One  drop  is  a  systemic  dose. 

Chloroform. — For  partial  anaesthesia,  can  be 
used  in  sensitive  dentine. 

R   Chloroform,  1  part; 

Ab.  Alcohol,  3  or  4  parts. 

Let  the  patient  hold  a  bottle  of  this  mixture 
under  the  nose  and  inhale  it  gently.  Produces 
chloroform  glow.  While  the  patient  is  under  its 
influence  almost  any  sensitive  tooth  can  be  easily 
excavated. 

Iodoform  Paste."^ 

R  Iodoform ,  gr.  xxx ; 

Tannic  Acid,  gr.  iij  ; 

Glycerine,  \  to  f  '^. 
Kub  in  mortar. 

This  is  very  useful  where  there  is  long  continued 
pus  formation,  is  antiseptic,  soothing,  etc. 

The  tannic  acid  overcomes  the  disagreeable  odor 
of  iodoform.     An  excellent  dressing  for  canals. 

Oil  of  Cajeput,  and  Oil  of  Eucalyptus. — 

Are  antiseptics  and  pus-stoppers ;  used  in  the  treat- 
ment of   chronic  cases,  perforated  foramina,  etc. 

*  Students'  list  of  medicaments. 


AND   THERAPEUTICS.  115 

Are  alterilative  medicaments ;  where  cajeput  seems 
contraindicated,  use  eucalyptus,  and  vice  verm. 

Fluid  Extract  of  Piscidia  (or  Jamaica  Dog- 
wood).— Used  in  difficult  devitalization;  canals  are 
filled  with  the  medicament,  gently  stopped,  and 
permitted  to  remain  so  for  a  few  days. 

Hydrate  of  Chloral. — (Strong  solution.) 

R  Hydrate  of  Chloral,  jiv  ; 
Aqua  Font.,  •^\. 

Is  a  splendid  pain-obtunder  and  soother  in  un- 
controllable peridental  trouble  when  other  remedies 
fail ;  is  jDlaced  in  the  canals  and  applied  to  the  gum. 

Is  also  excellent  for  obtunding  sensitive  dentine 
and  quieting  pulps ;  is  useful  in  idiosyncratic  cases. 

All  the  foregoing  aj^j^lications  are  used  inside  of 
teeth  as  a  rule. 

Arnica  and  Laudanum. — Equal  parts  of  each. 
Excellent  to  use  outside  and  inside  of  the  mouth  in 
cases  of  swelling,  pain,  etc.,  from  periosteal  trouble, 
where  a  tooth  has  been  extracted,  etc. 

Tincture  of  Capsicum. — Is  used  to  stimulate 
the  gums ;  can  be  used  combined  with  the  arnica 
and  laudanum,  the  caj^sicum  to  be  added  just  in 
proportion  as  patients  can  bear  the  stimulation  until 
pure  capsicum  alone  is  used. 

Capsicum  is  a  vital  irritant,  does  not  vesicate,  but 


116  DENTAL  PATHOLOGY 

stimulates ;  it  is  painted  on  the  gum  with  pellets  of 
cotton.  Diluted,  it  is  an  excellent  stimulating  wash 
for  injection  into  slow  and  chronic  abscess,  etc. 

Pepper  Bags. — Fill  with  equal  parts  of  ground 
pepper  and  ground  ginger ;  one  side  of  the  bags  is 
of  fine  rubber  cloth,  which  is  always  placed  in 
contact  with  the  cheek ;  the  other  side  is  of  muslin, 
which  is  placed  next  to  the  gum.  The  use  of  these 
bags  may  be  considered  chiefly  from  two  stand- 
points, viz. : 

1.  For  persistent,  gentle,  and  sufficient  stimula- 
tion to  effect  resolution. 

2.  For  persistent  and  sufficiently  decided  stimu- 
lation to  produce  suppuration. 

The  many  and  varied  stages  and  conditions  of 
pericemental  inflammation  which  are  usually  suc- 
cessfully met  by  the  proper  and  judicious  applica- 
tion of  pepper  bags,  range  from  that  tenderness 
which  is  often  induced  by  the  insertion  of  a  gold 
filling  to  that  active  inflammation  known  as  fourth- 
grade  periodontitis. 

The  fistulous  opening  which  is  so  easily  made  by 
the  wearing  of  a  pepper  bag,  as  a  rule,  heals  nicely 
without  the  use  of  any  medicament,  except  it  be 
Pond's  Extract  of  Hamamelis  or  Tincture  of  Calen- 
dula. 

Pepper  bags  are  nice  for  patients  to  carry  about 
with  them,  to  place  on  the  gum  in  case  of  any 
growling  or  tenderness  of  the  teeth. 


AND   THERAPEUTICS.  117 

The  oleo-resin  of  capsicin  remains  in  the  cap- 
sicum for  weeks,  as  it  is  only  slightly  soluble  in 
water ;  a  i^ej^per  bag,  therefore,  may  be  used  for 
weeks. 

Dental  Tincture  of  Iodine. '=' — (Prof.  Flagg 
remarks  "that  he  does  not  find  it  necessary  to  use 
it  more  than  half  a  dozen  times  a  year.") 

R  Iodine,  .^iii  or  iv  ; 
Alcohol,  5!. 

.  Set  it  away  for  a  few  days,  and  shake  frequently. 
A  pulp  after  capping  gives  a  little  trouble ;  den- 
tal tincture  of  iodine  spotted  on  the  gum  draws  away 
enough  blood  to  relieve  the  j^ulp,  etc. ;  used  also  in 
fungous  gum  and  j^ulp,  also  in  children's  teeth,  etc. 

Medicaments  for  syringing  outside  of  teeth  in 
patients  having  asthenic  attributes,  with  abscess 
trouble,  in  connection  with  fistulous  opening,  the 
pus  running  a  watery,  thin  fluid,  etc.  First  syringe 
out  with  water,  then  follow  with  hamamelis;  if, 
after  a  day  or  two,  bad  pus  continues,  use  tincture  of 
calendula  for  syringing  ;  it  is  very  healing,  etc. 

In  proportion  as  you  have  to  use  strong  medi- 
cines, just  so  in  proportion  the  heal  you  make 
is  not  good. 

R    i  part  of  Sulphuric  Acid  to  3  parts  of  Water. 

Is  as  good  as  Aromatic  Sulphuric  Acid.     Can 

*  Students'  list  of  medicaments. 


118  DENTAL  PATHOLOGY 

use  witli  absorbent  cotton  ;  use,  also,  if  the  calendula 
does  not  work  properly. 

Haemostatics,  Styptics. 

Tincture  of    Chenopodium   Album.     Pigweed.      (Not 
officinal.)     Used  with  light-haired  persons. 

Tincture  Erigeron  Canadensis.     (Officinal.)     For  dark- 
haired  patients. 

Dose, — Four  or  five  drops  in  a  glass  of  water. 
(See  page  104.) 

Nitric  Acid,  41°. — Nitric  acid  is  used  for  canker 
sores,  for  battery,  and  for  obtunding  sensitive  dentine. 

Cankers  act  differently  in  different  parts  of  the 
mouth  ;  under  the  tongue  or  on  the  gums  they  are 
very  painful,  etc. 

To  treat  them,  take  a  piece  of  stick,  dry  the 
canker  sore  by  turning  out  the  lip,  aj^plying  nap- 
kin, etc. ;  then  place  a  pellet  of  cotton  (saturated 
with  oil  of  cloves)  within  easy  reach.  Now  touch 
with  nitric  acid,  and  instantly  ap23ly  the  oil  of 
cloves ;  this  quiets  the  pain.  Usually  these  sores 
do  not  require  more  than  two  or  three  applications 
to  effect  a  cure. 

Caustic  Potassa. — Comes  in  sticks ;  is  used  for 
sensitive  dentine  after  carbonate  of  potassium  fails. 

OINTMENTS. 

Simple  Cerate. — Keep  in  a  porcelain  jar.  Use 
for  making  ointments,  anointing  glass  stoppers,  etc. 


AND    THERAPEUTICS.  HO 

Red  Precipitate  Ointment. — This  is  essential 
to  luive.     Is  useful  for  two  things. 

R   Red  Oxide  of  Mercury,  gr.  Ixii ; 
Yellow  Wax,  _^ii  ; 
Oil  of  Sweet  Almonds,  ^vi. 

The  above  way  of  preparing  prevents  it  from 
spoiling. 

To  ordinary  Red  Precipitate  Ointment  add  one 
or  two  drops  of  liquor  of  potassa  to  make  it  keep. 

Relieves  abrasions  at  corner  of  mouth,  scaly  and 
cracked  lips,  etc. 

Application. — Take  some  on  the  little  finger,  and 
rub  gently  but  firmly  across  the  lij)s ;  it  almost  in- 
stantly relieves  and  makes  the  lips  soft. 

A  deep  crack  is  often  noticed  in  the  centre  of  the 
lip  ;  this  the  ointment  relieves  promptly. 

A  little  of  the  ointment  is  taken  up  on  a  spatula 
and  placed  in  the  crack ;  in  a  day  or  two  have  the 
patient  return ;  then  3^ou  crack  the  lip  open  again 
and  apply  more  ointment,  and  in  a  few  days  all  is 
well.     Is  a  universal  lip  salve ;  keeps  well. 

Aconitia  Ointment.=== — For  application  outside 
of  the  mouth. 

R  Aconitia,  gr.  i  to  ii ; 
Simp.  Cerate,  ^i. 

There  are   numerous  applications  for  Aconitia 

*  Students'  list  of  medicaments. 


120  DENTAL  PATHOLOGY 

Ointment,  so  it  is  best  to  make  two  or  three  drachms 
at  least. 

To  make  it,  use  a  thin  spatula  and  a  smooth  plate 
or  slab.  Place  the  Aconitia  upon  it,  and  add  a  drop 
or  two  of  absolute  alcohol,  working  it  well  for  some 
time,  and  taking  great  pains  in  the  mixing ;  it  makes 
a  reddish,  yellowish  cream ;  then  add  little  by  little 
of  simple  cerate  at  a  time ;  if  too  thick,  use  a  drop 
or  two  of  alcohol ;  mix,  and  mix  thoroughly,  for 
half  an  hour ;  finally  comes  a  j^eculiar  change ;  it 
grows  tougher  and  tougher,  until  a  clicking  sound 
is  heard,  and  the  mass  looks  like  white  |)aint  or 
lead ;  it  is  then  finished. 

Uses. — Excellent  in  stiffness  of  jaws  induced  from 
any  of  various  causes.  Rub  a  little  over  affected 
parts,  and  the  jaw  soon  loosens,  etc. 

In  anaemic  patients,  in  long  operations,  apply 
freely  about  the  ramus  of  the  jaw  for  the  sake  of 
keeping  their  mouths  open ;  it  may  also  be  used, 
for  the  same  purpose,  in  examination  of  the  mouth. 

In  neuralgic  troubles  rub  some  on  the  face.  In 
swelling  cases  and  pendulous  appearance  of  lower 
jaw,  etc.,  rub  some  on;  is  a  noted pain-obtunder. 

Relieves  in  cases  of  sciatica ;  ruh  doion  from 
thigh  to  ankle ;  relieves  it  wonderfully. 

In  sprained  ankles,  rheumatism,  in  hoarseness  of 
throat,  where  there  is  trouble  to  swallow,  soreness, 
etc.,  gives  marked  relief  if  applied.  Great  care  is 
needful  in  the  use  of  this  ointment. 


AND  Tni:uAPi:i  TICS.  121 

Veratria  Ointment. — This  is  the  alternate  to 
Aconitia  Oiiitnieiit.     It  is  a  powerful  stimulator. 

li  Veriitria,  gr.  xx  ; 
Simp.  Cerate,  _:^i. 

Can  use  as  an  alternate.  For  exam2:)le,  where 
aconitia  will  not  work  in  neuralgia,  use  veratria. 
Rub  on  a  piece  the  size  of  a  quarter  of  a  pea.  It  is 
a  powerful  ointment ;  patients  will  notice  a  tingling, 
burning  sensation,  like  the  stinging  of  a  nettle ; 
use  gently.  Is  also  used  to  increase  the  action  of 
aconitia.     (Powerful  poison.) 

Iodide  of  Potassium  Ointment. 

R   Iodide  of  Potassium,  ^i  ; 
Simple  Cerate,  3!. 

Add  two  or  three  drops  of  liquor  of  potassa  to 
make  it  keep  well.  If  the  ointment  crystallizes, 
break  it  down  with  spatula.  It  is  a  sorbefacient 
used  to  rub  on  indurations,  etc. 

STIMULANTS. 

Eau  de  Cologne. — Is  used  to  smell  of,  and 
to  flavor  mouth  washes,  etc.  Some  persons  do  not 
like  cologne,  then  it  may  be  proper  to  offer  them 
spii'its  of  camphor. 

Smelling  Salts. — Powder  muriate  of  ammonia 
and  bicarbonate  of  soda  together  in  a  mortar ;  after 
powdering  add  some  oil  of  cloves,  place  it  in  a  bottle 

9 


122  DENTAL  PATHOLOGY. 

and  keep  it  tightly  corked  (a  bottle  witli  a  glass 
stopper  is  best);  as  soon  as  tlie  bottle  is  opened  the 
salt  is  ready  to  be  smelled  of.  Anoint  the  stopper 
with  simple  cerate. 

Asafoetida. — In  form  of  two-grain  pills  (sugar- 
coated)  is  used  for  administration  to  nervous  patients 
after  they  have  been  awake  all  night,  and  are  cross, 
weak,  irritable,  etc.  One  is  given  at  noon,  another 
at  night  before  going  to  bed,  another  the  following 
morning. 

Bi-Meconate  of  Morphia. — Is  an  alternate 
to  opium  administrations.  A  good  make  should 
remain  clear.  Is  not  a  constipator,  and  will  not 
keep  a  patient  awake,  but  soothes  and  quiets,  etc. 
Strength  of  solution  about  the  same  as  laudanum. 

Dose. — Half  to  three-quarters  of  a  teaspoonful 
at  a  dose. 


CAPSICUM    BAGS. 


Among  tlie  many  valuable  suggestions  wliicli 
Dr.  J.  F.  Flagg  has  made  to  the  dental  profession, 
capsicum  bags  are,  in  the  estimation  of  those  who 
have  learned  their  value,  considered  as  not  the 
least.  The  writer  is  thankful  for  the  relief  which 
he  has  experienced  in  person  and  Avitnessed  in  his 
patients  from  the  use  of  this  little  device.  These 
bags  when  applied  ^n-oduce  a  stimulation  ranging 
in  degree  from  that  which  is  slightly  irritant  to  that 
which  is  so  decided  as  to  produce  suj^puration  when 
continued.  In  all  cases  their  application  is  the 
same  as  regards  position, — the  linen  sides  being 
placed  next  to  the  gum  just  over  the  affected  tooth 
or  root,  the  seamless  end  of  the  bag  towards  the 
apex  of  the  root,  the  cheek  or  lip  being  protected 
by  the  rubber  side  of  the  bag  from  the  action  of 
the  contained  medicament.  In  cases  requiring 
more  or  less  continued  counter-irritation,  as  in  the 
conservative  treatment  of  pulj^s,  a  No.  2  bag  worn 
constantly  will  in  many  cases  prevent  undue  in- 
flammatory action  and  effusion.  If  pulps  after 
ca2)ping  give  slight  yet  increasing  response  to  ther- 


1-J3 


124  DENTAL  PATHOLOGY 

mal  changes,  a  No.  2  bag  should  be  worn  con- 
stantly in  order  to  counteract  incipient  inflamma- 
tory action.  The  tenderness  about  the  roots  of 
teeth  following  the  impaction  of  metallic  fillings, 
the  accidental  biting  on  a  hard  substance,  or  the 
overwork  of  lone  articulating  teeth  may  often  be 
quickly  dispersed  or  much  relieved  by  wearing  a 
No.  2  bag.  The  soreness  about  the  roots  of  teeth, 
which  is  frequently  a  sequence  of  wedging  in  cases 
of  irregularity,  etc.,  may  often  be  much  reduced  or 
entirely  dis23ersed  by  wearing  a  No.  2  bag.  Should 
this  fail  to  afford  relief  the  employment  of  cooling 
lotions  and  washes  should  be  directed,  as  also,  when 
indicated,  cathartics  and  general  sedatives.  Teeth 
from  which  the  j^ulps  have  been  extirpated  fre- 
quently after  being  filled  become  tender  and  sore. 
In  such  cases  the  No.  2  bag  should  be  applied  at 
once.  If,  as  occasionally  happens,  the  tenderness 
and  i^ain  should  be  increased  by  this  application, 
this  use  of  the  bag  should  be  discontinued,  and 
resort  should  be  had,  after  properly  venting  the 
tooth,  to  cooling  applications  and  systemic  treat- 
ment. If  these  measures  fail  in  turn,  then  the  ap- 
plication and  constant  wearing  of  a  No.  1  bag  is 
indicated,  with  proper  systemic  and  local  contribu- 
tive  treatment  should  the  swelling  increase  and 
systemic  excitement  occur.  In  these  cases  it  is  as- 
sumed that  proper  vent  has  been  given  to  the  tooth 
if  the  soreness  increases  after  the  application  of  a 


AND    THERAPEUTICS.  125. 

No.  2  bag,  or  that  venting,  if  at  all  practicable, 
would  be  a  difficult  and  painful  operation,  wliieli, 
even  if  accomplished,  would  probably  not  prevent 
the  formation  of  abscess.  It  is  also  assumed  tliat 
whether  such  tooth  has  been  vented  or  not,  it  has 
been  guarded  from  occlusion.  In  teeth  which  have 
been  properly  vented  there  is  generally  no  occasion 
for  more  energetic  treatment  than  the  wearing  of  a 
capsicum  bag,  even,  in  many  cases,  to  the  estab- 
lishment of  a  fistulous  opening.  In  that  class  of 
cases  which  cannot  be  satisfactorily  vented,  decided 
local  and  systemic  abortive  treatment  is  required  in 
order  to  effect  resolution.  Frequently,  however, 
all  abortive  measures  fail,  and  the  prompt  estab- 
lishment of  abscess  presents  the  only  means  of 
avoiding  the  extraction  of  the  tooth.  In  such 
cases  a  No.  1  l^ag  should  always  be  worn. 

An  abscess  is  more  or  less  restricted,  more  or  less 
difficult  to  control,  and  more  or  less  distressing  to 
the  2^atient  according  to  its  position,  whether  in 
the  ui^per  or  lower  jaw,  in  the  anterior  or  ^^osterior 
j^ortion  of  the  mouth.  The  temperament  and 
physical  condition  of  the  individual,  the  time  of 
the  year,  and  other  circumstances,  influence  mark- 
edly its  extent,  duration,  and  the  degree  of  its  re- 
sponse to  treatment.  When  attended  with  much 
edema  and  systemic  disturbance,  the  most  positive 
and  2)owerful  sedative,  astringent,  and  cooling  aj)- 
plications,  with  direct  and  continued  systemic  treat- 


126  DENTAL  PATHOLOGY 

ment,  are  demanded  to  prevent  untoward,  even 
disastrous,  results.  In  cases  exhibiting  such  ex- 
treme symptoms,  when  the  effort  is  to  be  made 
toward  saving  a  tooth  so  involved,  the  patient 
should  be  instructed  to  partake  frequently,  in  small 
quantity,  of  nourishing  and  easily  swallowed  food, 
as  light  soups,  broths,  beef- tea,  minced  rare  beef, 
ta23ioca,  etc.  He  should  also  be  instructed  as  to 
the  jDi'oper  position  during  rest  or  sleep.  When 
the  pain  of  active  inflammation  has  subsided,  and 
the  formation  of  pus  begun,  the  lance  may  in  many 
cases  be  used  to  anticipate  the  natural  yet  more 
tedious  pointing.  In  some  cases  a  fistula  may  be 
at  once  established  by  drilling  through  the  aveolar 
process. 

In  the  case  of  a  tooth  having  had  a  putrescent 
pulp,  the  tenderness  which  follows  treatment  and 
filling  will  generally  respond  very  promptly  to  the 
application  of  a  No.  2  bag.  If  soreness  and 
"growling"  continue,  a  saline  cathartic  may  be 
taken,  or  one  or  more  doses  of  bromide  of  potas- 
sium, 40  to  80  grains.  If,  however,  in  such  cases 
the  capsicum  bag  be  applied  at  the  first  intimation 
of  trouble,  it  will  nearly  always  prevent  the  neces- 
sity of  further  treatment.  In  the  treatment  of 
teeth  with  putrescent  pulps  a  decided  periodontitis 
is  frequently  only  held  in  abeyance  either  by  leav- 
ing the  canals  of  such  teeth  entirely  ojDen  or  by 
dressing  them  in  the  loosest  manner  possible.    Such 


AXJ)    TIliniAPEUTICK.  127 

cases  should  wear  a  No.  2  bag  constantly  during 
the  effort  to  secure  toleration  by  a  gradual  in- 
crease of  the  tightness  of  the  canal  dressings.  If 
all  efforts  fail,  the  dressing  should  be  firmly  intro- 
duced, the  cavity  temporarily  filled,  and  a  No.  1 
bag  worn  as  nearly  constantly  as  the  high  grade  of 
stimulation  will  permit,  removing  it  at  intervals 
if  the  pain  be  too  severe.'^ 

An  abscess,  more  or  less  advanced,  without  a 
fistula,  connected  watli  a  tooth  which  has  been 
filled,  is  a  common  form  of  dental  trouble  for 
which  new  patients  or  transient  applicants  seek 
relief.  If  the  venting  of  such  a  tooth  is  imprac- 
ticable or  fails  to  relieve,  a  No.  1  bag  should  be 
worn  until  the  lance  or  natural  discharge  afford 
relief  in  all  cases  where  it  is  desirable  that  the 
tooth  should  be  saved. 

Sometimes  patients  while  having  teeth  with  pu- 
trescent puljis  treated  are  compelled  to  leave  home 
by  the  demands  of  business  before  the  teeth  are 
properly  prepared  even  for  temporary  fdling.  In 
these  cases  the  teeth  should  be  dressed  with  a  tem- 
porary material  permitting  of  easy  venting,  if  de- 
sired, and  the  j^atient  directed,  upon  the  first  indi- 
cation of  uneasiness  about  the  tooth,  to  apply  and 
wear  a  No.  2  bag,  or  in  sluggish  temperaments  a 

*When  opening  into  and  treating  teeth  with  putrescent  pulps,  it 
is  good  practice  generally  to  give  to  patients,  at  the  beginning  of  the 
operation,  from  forty  to  sixty  grains  of  Bromide  of  Potassium. 


128  DENTAL  PATHOLOGY 

No.  1,  until  every  uneasy  sensation  has  passed 
away.  Should  the  aioj^lication  prove  ineffectual, 
the  vent  should  be  opened  and  permitted  so  to 
remain  until  all  disturbance  has  subsided,  when 
the  vent  may  be  loosely  stopjDcd  with  cotton. 
With  proper  attention  to  these  directions,  such 
cases  may  be  carried  along  for  months  without 
decided  trouble. 

If  the  wearing  of  a  capsicum  bag  increases  pain, 
then  its  use,  except  when  abscess  is  desired,  is  con- 
tra-indicated, and  cooling  astringent  and  sedative 
applications  should  be  substituted.  This  caution 
should  always  be  given  to  patients,  and  as  well  the 
direction  that,  when  pain  is  relieved  by  their  use, 
they  should  be  worn  a  few  hours  or  days  after  the 
disappearance  of  the  uneasiness,  that  the  beneficial 
imjDression  be  rendered  more  decided  and  perma- 
nent. Patients  sometimes  imagine  that  a  capsicum 
bag,  after  having  been  worn  for  a  short  j^eriod,  has 
lost  its  strength.  This  is  because  the  parts  have 
become  tblerant  of  the  presence  and  action  of  the 
medicament,  and  not  because  of  any  lessened  ac-- 
tivity  of  the  capsicum. 

It  will  be  understood  that  the  No.  1  bags  should 
contain  pure  capsicum,  and  the  No.  2  equal  parts 
of  capsicum  and  ginger. 

In  cases  where  the  stimulation  of  capsicum  bags 
increases  or  fails  to  diminish  pain  or  tenderness, 
except  when  the  formation  of  an  abscess  is  desired, 


AM)    TllKJiAI'EUTlCS.  129 

the  ])roiiipt  and  continued  use  of  a  bag  (Compound 
Bag),  similarly  made  and  worn  ai^  the  cjipsicum 
bags,  containing  soothing,  cooling,  and  astringent 
drugs,  such  as  chlorate  of  potassium,  hamamelis, 
and   tannic  acid,  is   indicated. 


RK57 


W59 
1885 


Quiz  quec-tions. 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsi.stx) 

RK57W59  1885C.1 

Quiz  questions:  course  on  dental  oatholo 


2002339803 


